Provider Demographics
NPI:1144256736
Name:ONCOLOGICS, INC.
Entity type:Organization
Organization Name:ONCOLOGICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:MAITLAND
Authorized Official - Last Name:DELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-237-2057
Mailing Address - Street 1:917 GENERAL MOUTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8511
Mailing Address - Country:US
Mailing Address - Phone:337-237-2057
Mailing Address - Fax:337-264-1029
Practice Address - Street 1:917 GENERAL MOUTON AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8511
Practice Address - Country:US
Practice Address - Phone:337-237-2057
Practice Address - Fax:337-264-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA01794678Medicaid
LA01794678Medicaid
MSC00923Medicare PIN