Provider Demographics
NPI:1821252115
Name:ROSWELL PARK CANCER INSTITUTE
Entity Type:Organization
Organization Name:ROSWELL PARK CANCER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIC ONCOLOGY FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:QIUXI
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-845-7100
Mailing Address - Street 1:ROSWELL PARK CANCER INSTITUTE DEPARTMENT OF
Mailing Address - Street 2:ELM & CARLTON STREETS
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-7100
Mailing Address - Fax:
Practice Address - Street 1:ROSWELL PARK CANCER INSTITUTE DEPT OF
Practice Address - Street 2:ELM & CARLTON STREETS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241734284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital