Provider Demographics
NPI:1447252762
Name:CENTRAL PENNSYLVANIA HEMATOLOGY & MEDICAL ONCOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:CENTRAL PENNSYLVANIA HEMATOLOGY & MEDICAL ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:717-599-5502
Mailing Address - Street 1:50 N 12TH ST UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1428
Mailing Address - Country:US
Mailing Address - Phone:717-737-5767
Mailing Address - Fax:717-737-5868
Practice Address - Street 1:50 N 12TH ST UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1428
Practice Address - Country:US
Practice Address - Phone:717-737-5767
Practice Address - Fax:717-737-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACN2083OtherPALMETO GBA-UNITED HEALTHCARE MEDICARE
PA2149OtherCOVENTRY
PA1007720560004Medicaid
PA4536959OtherAETNA
PA761002OtherHIGHMARK BLUE SHIELD
PA02508600OtherCAPITAL BLUE CROSS
PA02508600OtherCAPITAL BLUE CROSS
PA0830200001Medicare NSC