Organization
NORTHSHORE ONCOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL R NOWACKI (BUSINESS MANAGER)
(225) 215-1223
Entity
Organization
Contact information
Practice address
1203 S TYLER ST, STE 100, COVINGTON, LA 70433-2353
(985) 892-9090
(985) 892-9957
Mailing address
4950 ESSEN LANE, ATTN KRISTI SIEMANN, BATON ROUGE, LA 70809-3482
(225) 215-1311
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2142089
—
LA
01
—
3855298
MISSISSIPPI MEDICAID
MS
Enumeration date
03/11/2011
Last updated
04/26/2012
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