1235431248 NPI number — CAMBRIDGE CANCER & INFUSION CENTER LLC

Table of content: (NPI 1235431248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235431248 NPI number — CAMBRIDGE CANCER & INFUSION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIDGE CANCER & INFUSION CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235431248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-645-4242
Provider Business Mailing Address Fax Number:
301-705-7512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 OLD WASHINGTON RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-645-4242
Provider Business Practice Location Address Fax Number:
301-705-7512
Provider Enumeration Date:
11/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MATHUR
Authorized Official First Name:
KRISHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
301-645-4242

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3300081 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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