Provider Demographics
NPI:1295808996
Name:LAFAYETTE CANCER CARE, PC
Entity type:Organization
Organization Name:LAFAYETTE CANCER CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:764-446-5050
Mailing Address - Street 1:1345 UNITY PL
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5760
Mailing Address - Country:US
Mailing Address - Phone:765-446-5050
Mailing Address - Fax:765-446-5119
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 135
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5760
Practice Address - Country:US
Practice Address - Phone:765-446-5050
Practice Address - Fax:765-446-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045452A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING31250Medicare UPIN
814560AMedicare ID - Type Unspecified