Provider Demographics
NPI:1447674742
Name:DELTA ONCOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DELTA ONCOLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GRIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-396-6348
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-396-6348
Mailing Address - Fax:757-396-6121
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-397-3400
Practice Address - Fax:757-399-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010583592471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty