Basic Information
| Provider Information | |||||||||
| NPI: | 1992721153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LYNCHBURG HEMATOLOGY ONCOLOGY CLINIC INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 THOMSON DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245011101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342005925 | ||||||||
| FaxNumber: | 4342005929 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 THOMSON DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245011101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342005925 | ||||||||
| FaxNumber: | 4342005929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 11/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLDHAM | ||||||||
| AuthorizedOfficialFirstName: | DWIGHT | ||||||||
| AuthorizedOfficialMiddleName: | STEPHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4342005925 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101028991 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.