Healthcare Provider Details

I. General information

NPI: 1043345259
Provider Name (Legal Business Name): ANCHORAGE ONCOLOGY CENTRE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 LAKE OTIS PKWY SUITE B2
ANCHORAGE AK
99508-5214
US

IV. Provider business mailing address

4231 LAKE OTIS PKWY SUITE B2
ANCHORAGE AK
99508-5214
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-2627
  • Fax: 907-569-2626
Mailing address:
  • Phone: 907-569-2627
  • Fax: 907-569-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberAA2285
License Number StateAK

VIII. Authorized Official

Name: LATHA SUBRAMANIAN
Title or Position: MEMBER
Credential: M.D.
Phone: 907-569-2627