Provider Demographics
NPI:1689059909
Name:MODERN CANCER CARE, LLC
Entity Type:Organization
Organization Name:MODERN CANCER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:HALI
Authorized Official - Suffix:
Authorized Official - Credentials:GLOBAL MBA
Authorized Official - Phone:347-585-8001
Mailing Address - Street 1:212 E LEXINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3501
Mailing Address - Country:US
Mailing Address - Phone:410-385-8200
Mailing Address - Fax:
Practice Address - Street 1:212 E LEXINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3501
Practice Address - Country:US
Practice Address - Phone:410-385-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212315364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncologyGroup - Single Specialty