Basic Information
| Provider Information | |||||||||
| NPI: | 1073660122 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR CANCER AND BLOOD DISORDERS | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | SUITE 660 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015710019 | ||||||||
| FaxNumber: | 2404820555 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | STE 660 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015710019 | ||||||||
| FaxNumber: | 2404820555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUFFMAN | ||||||||
| AuthorizedOfficialFirstName: | CARREEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINSTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3015710019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | D0029675 | MD | Y | Suppliers | Non-Pharmacy Dispensing Site |
ID Information
| ID | Type | State | Issuer | Description | 350491300 | 05 | MD | MEDICAID | 2132215 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER |