Provider Demographics
NPI:1649298498
Name:CANCER CARE FOR WOMEN PC
Entity type:Organization
Organization Name:CANCER CARE FOR WOMEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-544-3190
Mailing Address - Street 1:694 GOOD DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604
Mailing Address - Country:US
Mailing Address - Phone:717-544-3190
Mailing Address - Fax:717-544-3189
Practice Address - Street 1:694 GOOD DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604
Practice Address - Country:US
Practice Address - Phone:717-544-3190
Practice Address - Fax:717-544-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019140550002Medicaid
PA021831Q42OtherMEDICARE PTAN
PA021831Q42OtherMEDICARE PTAN