Provider Demographics
NPI:1780879148
Name:CANCER CENTER OF NORTHWEST OHIO
Entity type:Organization
Organization Name:CANCER CENTER OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-422-5075
Mailing Address - Street 1:2461 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1167
Mailing Address - Country:US
Mailing Address - Phone:419-422-5075
Mailing Address - Fax:419-422-5490
Practice Address - Street 1:2461 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1167
Practice Address - Country:US
Practice Address - Phone:419-422-5075
Practice Address - Fax:419-422-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4966720001Medicare NSC