Provider Demographics
NPI:1578959615
Name:PROGRESSIVE ONCOLOGY AND HEMATOLOGY CENTER LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ONCOLOGY AND HEMATOLOGY CENTER LLC
Other - Org Name:PROGRESSIVE ONCOLOGY AND HEMATOLOGY CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-682-2988
Mailing Address - Street 1:2405 WHITTIER DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3361
Mailing Address - Country:US
Mailing Address - Phone:016-822-9883
Mailing Address - Fax:301-682-2989
Practice Address - Street 1:2405 WHITTIER DR UNIT 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3361
Practice Address - Country:US
Practice Address - Phone:301-682-2988
Practice Address - Fax:301-682-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty