Basic Information
| Provider Information | |||||||||
| NPI: | 1972956605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH ONCOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 AMHERST ST STE F | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406621108 | ||||||||
| FaxNumber: | 5404502244 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226016906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406621108 | ||||||||
| FaxNumber: | 5404502244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2016 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | GROESE | ||||||||
| AuthorizedOfficialFirstName: | LORNA | ||||||||
| AuthorizedOfficialMiddleName: | CORRINE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5406621108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101041458 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.