Provider Demographics
NPI:1922344985
Name:CANCER PROFESSIONALS OF GREATER WASHINGTON, PLLC
Entity Type:Organization
Organization Name:CANCER PROFESSIONALS OF GREATER WASHINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:I
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-477-6620
Mailing Address - Street 1:15225 SHADY GROVE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3254
Mailing Address - Country:US
Mailing Address - Phone:240-477-6620
Mailing Address - Fax:240-477-6495
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:240-477-6620
Practice Address - Fax:240-477-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074563207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty