Provider Demographics
NPI:1750413241
Name:EASTSIDE HEMATOLOGY ONCOLOGY
Entity type:Organization
Organization Name:EASTSIDE HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:PINJAI
Authorized Official - Middle Name:RAMADAS
Authorized Official - Last Name:RAVICHANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-244-6777
Mailing Address - Street 1:PO BOX 26683
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1683
Mailing Address - Country:US
Mailing Address - Phone:864-244-6777
Mailing Address - Fax:
Practice Address - Street 1:4210 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2423
Practice Address - Country:US
Practice Address - Phone:864-244-6777
Practice Address - Fax:864-244-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6387Medicare PIN