Basic Information
| Provider Information | |||||||||
| NPI: | 1093851826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR CANCER AND BLOOD DISORDERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | SUITE 660 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015710019 | ||||||||
| FaxNumber: | 3015710988 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | SUITE 660 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015710019 | ||||||||
| FaxNumber: | 3015710988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUFFMAN | ||||||||
| AuthorizedOfficialFirstName: | CARREEN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2404820500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 6896VM | 01 | MD | CAREFIRST MD GROUP NUMBER | OTHER | 7007 | 01 | MD | CAREFIRST GROUP NUMBER | OTHER | 406031800 | 05 | MD | MEDICAID |