Organization
ONCO DIAGNOSTIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANHO H PARK M.D. (MEDICAL DIRECTOR)
(706) 546-0200
Entity
Organization
Contact information
Practice address
812 HURON RD E, SUITE 520, CLEVELAND, OH 44115-1123
(216) 861-5846
(216) 861-1720
Mailing address
PO BOX 72501, CLEVELAND, OH 44192-0501
(706) 546-0200
(706) 546-6522
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
35031213
OH
291U00000X
Clinical Medical Laboratory
36D0656045
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0893547
—
OH
Enumeration date
06/29/2006
Last updated
07/22/2011
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