Provider Demographics
NPI:1134245004
Name:EASTERN SHORE ONCOLOGY PC
Entity type:Organization
Organization Name:EASTERN SHORE ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:DE SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-819-3332
Mailing Address - Street 1:509 IDLEWILD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3889
Mailing Address - Country:US
Mailing Address - Phone:410-819-3332
Mailing Address - Fax:410-819-3322
Practice Address - Street 1:509 IDLEWILD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3889
Practice Address - Country:US
Practice Address - Phone:410-819-3332
Practice Address - Fax:410-819-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47232207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402275100Medicaid
MD402275100Medicaid