Provider Demographics
NPI:1053371245
Name:JEFFERSON/UPMC CANCER ASSOCIATES
Entity type:Organization
Organization Name:JEFFERSON/UPMC CANCER ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - CANCER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-2451
Mailing Address - Street 1:5150 CENTRE AVE
Mailing Address - Street 2:ROOM 456
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1309
Mailing Address - Country:US
Mailing Address - Phone:414-223-5127
Mailing Address - Fax:412-648-6985
Practice Address - Street 1:565 COAL VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205
Practice Address - Country:US
Practice Address - Phone:412-205-6300
Practice Address - Fax:412-205-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098859U4CMedicare ID - Type Unspecified