Provider Demographics
NPI:1871923755
Name:OHIO HEMATOLOGY ONCOLOGY LLC
Entity type:Organization
Organization Name:OHIO HEMATOLOGY ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LODHAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-223-2600
Mailing Address - Street 1:1071 HARDING MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6315
Mailing Address - Country:US
Mailing Address - Phone:740-223-2600
Mailing Address - Fax:740-223-2611
Practice Address - Street 1:1071 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6315
Practice Address - Country:US
Practice Address - Phone:740-223-2600
Practice Address - Fax:740-223-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949322Medicaid
OHPENDINGMedicare UPIN