Organization
CENTRAL VIRGINIA ONCOLOGY, INC.
Active
Other names
Petersburg Oncology, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA MAE FUKUMOTO MD (PRES, UP, SEC, TREAS)
(804) 732-7900
Entity
Organization
Contact information
Practice address
700 S SYCAMORE ST, STE 10, PETERSBURG, VA 23803
(804) 732-7900
(804) 732-7592
Mailing address
700 S SYCAMORE ST, STE 10, PETERSBURG, VA 23803
(804) 732-7900
(804) 732-7592
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101030480
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112949936
MEDICARE ID
VA
01
—
268028
MAMIS/OPT.CHOICE
VT
01
—
274304
BLUE CROSS AND BLUE SHELD
VA
01
—
3600128
UNITED HEALTH
VA
01
—
59455
SOUTHERN HEALTH
VA
05
—
6090575
—
VA
01
—
P00145587
RAIL ROAD MEDICARE
VA
Enumeration date
08/21/2006
Last updated
07/06/2011
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