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PENINSULA CANCER INSTITUTE LLC NPI 1710180120


NPI Information

NPI: 1710180120
Provider Name: PENINSULA CANCER INSTITUTE, LLC

Doing Business As: CANCER SPECIALISTS OF TIDEWATER

Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

CLIA Number: 49D0229965

Address:
110 WIMBLEDON SQ
SUITE E
CHESAPEAKE, VA
ZIP 23320
Phone: (757) 436-2995
Get Directions

PENINSULA CANCER INSTITUTE, LLC is a hematology and oncology internal medicine in Chesapeake, VA. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. PENINSULA CANCER INSTITUTE, LLC NPI is 1710180120. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Cancer Specialists Of Tidewater.

The provider's business location address is:

110 WIMBLEDON SQ
SUITE E
CHESAPEAKE, VA
ZIP 23320-946
Phone: (757) 436-2995
Fax: (757) 436-2912

The provider's authorized official is James Lesnick .
The authorized official title is Vice President and has the following contact phone number (757) 594-4006.

The CLIA number assigned to this NPI record is 49D0229965 - public health laboratories with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/6/2007 and was last updated on 12/15/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1C09380MEDICARE PINVIRGINIA
26122940001MEDICARE NSCVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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