Provider Demographics
NPI:1871776856
Name:PEDIATRIC HEMATOLOGY-ONCOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:PEDIATRIC HEMATOLOGY-ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-453-2013
Mailing Address - Street 1:405 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2003
Mailing Address - Country:US
Mailing Address - Phone:203-453-2013
Mailing Address - Fax:203-453-6404
Practice Address - Street 1:405 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2003
Practice Address - Country:US
Practice Address - Phone:203-453-2013
Practice Address - Fax:203-453-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0301352080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E46532Medicare UPIN