Provider Demographics
NPI:1487099958
Name:DELTA ONCOLOGY, INC.
Entity type:Organization
Organization Name:DELTA ONCOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-3167
Mailing Address - Street 1:333 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6538
Mailing Address - Country:US
Mailing Address - Phone:662-453-3167
Mailing Address - Fax:662-453-9180
Practice Address - Street 1:333 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6538
Practice Address - Country:US
Practice Address - Phone:662-453-3167
Practice Address - Fax:662-453-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14648261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1871607598OtherPROVIDER NPI NUMBER
DU4354OtherRAILROAD MEDICARE PTAN
MS07370553Medicaid
MS07370553Medicaid
MS326762Medicare PIN