PENINSULA CANCER INSTITUTE LLC (NPI# 1710218664) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710218664 |
| Entity Type | Organization |
| Organization Name | PENINSULA CANCER INSTITUTE LLC |
| Other Organization Name | SHORE CANCER INSTITUTE |
| Practice Address |
20480 Market Street Onancock VA 23417 |
| Mailing Address |
856 J Clyde Morris Blvd Ste A Newport News VA 23601-1318 |
| Practice Telephone | 7573022600 |
| Mailing Telephone | 7573165960 |
| Mailing Fax Number | 7575345190 |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2017-02-09 |
| Authorized Official Name | BRADEN MILLER (CFO) |
| Authorized Official Telephone | 7573165800 |
| Is Organization Subpart | Y |
| Parent Organization Name | RIVERSIDE HEALTHCARE ASSOCIATES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Shore Cancer Institute | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306383781 | Peninsula Cancer Institute LLC | Internal Medicine | 659 Hospital Rd, Suite 201, Tappahannock, VA 22560-7000 | 2017-01-24 |
| Street Address |
20480 MARKET STREET |
| City | ONANCOCK |
| State | VA |
| Zip Code | 23417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265420582 | Jefferson Eaddy Carter Moulds | Radiology | 20480 Market Street, Onancock, VA 23417-0430 | 2005-10-11 |
| 1417495367 | Riverside Physician Services Inc | Radiology | 20480 Market Street, Onancock, VA 23417 | 2017-02-10 |
| 1649686429 | Abdallah Abdelrazeq | Internal Medicine | 20480 Market Street, Onancock, VA 23417 | 2014-07-01 |
| 1134453137 | Riverside Physician Services, Inc | Hospitalist | 20480 Market Street, Onancock, VA 23417 | 2009-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710593025 | Dawn Alison Craig | Speech-Language Pathologist | 25221 Savageville Road Unit A, Onancock, VA 23417 | 2020-09-22 |
| 1679827687 | James J James | Preventive Medicine | 16422 Wanderers Port Lane, Onancock, VA 23417 | 2012-10-30 |
| 1619076916 | Shore Health Services Inc. | General Acute Care Hospital | 20480 Market St, Onancock, VA 23417 | 2006-09-22 |
| 1952330219 | Bruce Alan Krueger | Podiatrist | 20190 Market St., Onancock, VA 23417 | 2006-06-30 |
| 1639178122 | Michael Grillon | Family Medicine | 20486 Market Street, Onancock, VA 23417 | 2005-07-18 |
| 1821591942 | Sarah Mears Chew | Speech-Language Pathologist | 20486 Market Street, Onancock, VA 23417 | 2018-03-15 |
| 1801334297 | Riverside Physician Services Inc | Family Medicine | 20486 Market Street, Onancock, VA 23417 | 2017-02-06 |
| 1346525128 | Allen Ozeran | Internal Medicine | 20486 Market Street, Onancock, VA 23417 | 2011-10-12 |
| 1366726077 | Rudra Beharrysingh | Internal Medicine | 20480 Market St, Onancock, VA 23417 | 2011-09-30 |
| 1730474115 | Ambar Matta | Surgery | 20486 Market Street, Onancock, VA 23417 | 2011-06-14 |
| Find all providers in zip 23417 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| 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. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093339764 | Loudoun Medical Group . P.c | Internal Medicine | 19500 Sandridge Way Ste 400, Leesburg, VA 20176-3691 | 2020-05-29 |
| 1316566839 | Stephen Smith Kennedy | Internal Medicine | 1108 Doe Mountain Rd, Goodview, VA 24095-2496 | 2020-04-14 |
| 1740640804 | Virginia Hematology Oncology Physicians Inc | Internal Medicine | 2556 Fox Hound Ct, Herndon, VA 20171-2996 | 2016-03-02 |
| 1326423260 | John J Welch | Internal Medicine | 2040 Antananarivo Pl, Dulles, VA 20189-2039 | 2015-07-21 |
| 1144637786 | Toshihisa Satta | Internal Medicine | 1250 E Marshall St # 980509, Richmond, VA 23298-5051 | 2014-07-15 |
| 1366860496 | Krista Isaac | Internal Medicine | 1215 Lee St - Box Number 800716, Charlottesville, VA 22908-0001 | 2014-04-05 |
| 1760800858 | Sonia Esparza Hepburn | Internal Medicine | 500 Sentara Cir Ste 203, Williamsburg, VA 23188-5727 | 2014-04-04 |
| 1326485202 | Kristopher Joel Hansen | Internal Medicine | 2600 Research Center Dr Ste A, Blacksburg, VA 24060 | 2013-05-31 |
| 1528326329 | Rahul Singh | Internal Medicine | 8101 Hinson Farm Rd Ste 211, Alexandria, VA 22306 | 2012-04-30 |
| 1821363219 | Oliver Alabaster | Internal Medicine | 4318 Adrienne Dr, Alexandria, VA 22309-2803 | 2012-03-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.