Provider Demographics
NPI:1174577118
Name:GASTON HEMATOLOGY & ONCOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:GASTON HEMATOLOGY & ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:704-865-5210
Mailing Address - Street 1:2610 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0637
Mailing Address - Country:US
Mailing Address - Phone:704-865-5210
Mailing Address - Fax:704-865-6282
Practice Address - Street 1:2610 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0637
Practice Address - Country:US
Practice Address - Phone:704-865-5210
Practice Address - Fax:704-865-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0126WOtherBCBS NC
SCNPA805Medicaid
NC890126WMedicaid
NC890126WMedicaid