Provider Demographics
NPI:1053397745
Name:HEMATOLOGY ONCOLOGY PATIENT ENTERPRISES P C
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY PATIENT ENTERPRISES P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-982-8410
Mailing Address - Street 1:459 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4808
Mailing Address - Country:US
Mailing Address - Phone:434-982-8410
Mailing Address - Fax:434-982-8420
Practice Address - Street 1:459 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4808
Practice Address - Country:US
Practice Address - Phone:434-982-8410
Practice Address - Fax:434-982-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03283Medicare PIN