Provider Demographics
NPI:1881631737
Name:PHYSICIAN ONCOLOGY, LTD.
Entity type:Organization
Organization Name:PHYSICIAN ONCOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-5500
Mailing Address - Street 1:9600 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3932
Mailing Address - Country:US
Mailing Address - Phone:215-677-5500
Mailing Address - Fax:
Practice Address - Street 1:9600 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3932
Practice Address - Country:US
Practice Address - Phone:215-677-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016271E302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPH044431Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER