Provider Demographics
NPI:1508901422
Name:CANCER QUALITY CARE LLC
Entity Type:Organization
Organization Name:CANCER QUALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-493-0400
Mailing Address - Street 1:PO BOX 34975
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20827-0975
Mailing Address - Country:US
Mailing Address - Phone:301-493-0400
Mailing Address - Fax:301-493-0037
Practice Address - Street 1:4416 E WEST HWY STE 410
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4568
Practice Address - Country:US
Practice Address - Phone:301-493-0400
Practice Address - Fax:301-493-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM54084207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01394Medicare PIN
MDH68508Medicare UPIN