Basic Information
| Provider Information | |||||||||
| NPI: | 1619111622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA CANCER INSTITUTE-NEW HOPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7324 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346545518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274847722 | ||||||||
| FaxNumber: | 7274847781 | ||||||||
| Practice Location | |||||||||
| Address1: | 8763 RIVER CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278428411 | ||||||||
| FaxNumber: | 7278472923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | CARADONNA | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3525961926 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2660377-00 | 05 | FL | MEDICAID | 5540000003 | 01 | FL | PTAN | OTHER |