Provider Demographics
NPI:1780364240
Name:PLEASANT LAKE CANCER CENTER LLC
Entity type:Organization
Organization Name:PLEASANT LAKE CANCER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD MPH
Authorized Official - Phone:617-785-2066
Mailing Address - Street 1:25 TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2638
Mailing Address - Country:US
Mailing Address - Phone:617-785-2066
Mailing Address - Fax:
Practice Address - Street 1:253 PLEASANT LAKE AVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2552
Practice Address - Country:US
Practice Address - Phone:617-785-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty