Provider Demographics
NPI:1841267275
Name:SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI
Entity type:Organization
Organization Name:SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - CANCER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-2451
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N430
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-7706
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:1600 CORAOPOLIS HEIGHTS RD
Practice Address - Street 2:SUITE F
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4316
Practice Address - Country:US
Practice Address - Phone:412-329-2500
Practice Address - Fax:412-329-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D1027607291U00000X
207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA951583OtherHIGHMARK
PA0018806270007Medicaid
PA0018806270008OtherCLIA LAB
OH2517655Medicaid
WV3810011966Medicaid
PA049781PZBMedicare PIN
OH2517655Medicaid