Provider Demographics
NPI:1235431248
Name:CAMBRIDGE CANCER & INFUSION CENTER LLC
Entity Type:Organization
Organization Name:CAMBRIDGE CANCER & INFUSION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-645-4242
Mailing Address - Street 1:PO BOX 2729
Mailing Address - Street 2:
Mailing Address - City:LAPLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-2729
Mailing Address - Country:US
Mailing Address - Phone:301-645-4242
Mailing Address - Fax:301-705-7512
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:STE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-645-4242
Practice Address - Fax:301-705-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3300081Medicaid
MD3300081Medicaid