Provider Demographics
NPI:1447365945
Name:CENTRAL VIRGINIA ONCOLOGY, INC.
Entity type:Organization
Organization Name:CENTRAL VIRGINIA ONCOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES, UP, SEC, TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:FUKUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-732-7900
Mailing Address - Street 1:700 S SYCAMORE ST
Mailing Address - Street 2:STE 10
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803
Mailing Address - Country:US
Mailing Address - Phone:804-732-7900
Mailing Address - Fax:804-732-7592
Practice Address - Street 1:700 S SYCAMORE ST
Practice Address - Street 2:STE 10
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-732-7900
Practice Address - Fax:804-732-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA274304OtherBLUE CROSS AND BLUE SHELD
VA6090575Medicaid
VA3600128OtherUNITED HEALTH
VA112949936OtherMEDICARE ID
VAP00145587OtherRAIL ROAD MEDICARE
VA59455OtherSOUTHERN HEALTH
VT268028OtherMAMIS/OPT.CHOICE
VA274304OtherBLUE CROSS AND BLUE SHELD
VA112949936OtherMEDICARE ID
VAP00145587OtherRAIL ROAD MEDICARE