Provider Demographics
NPI:1902998867
Name:COMMUNITY HEMATOLOGY ONCOLOGY PRACTITIONERS PC
Entity Type:Organization
Organization Name:COMMUNITY HEMATOLOGY ONCOLOGY PRACTITIONERS PC
Other - Org Name:COMMUNITY HEMATOLOGY ONCOLOGY PRACTITIONERS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-774-6136
Mailing Address - Street 1:18111 PRINCE PHILIP DRIVE
Mailing Address - Street 2:SUITE 327
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-774-6136
Mailing Address - Fax:301-570-0136
Practice Address - Street 1:18111 PRINCE PHILIP DRIVE
Practice Address - Street 2:SUITE 327
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-6136
Practice Address - Fax:301-570-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD131901900Medicaid
599085Medicare PIN