Healthcare Provider Details

I. General information

NPI: 1003677014
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 EDGERTON DR STE A
NORTH FALMOUTH MA
02556-2820
US

IV. Provider business mailing address

500 FRANK W BURR BLVD SUITE 560 MAILBOX 29
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 508-564-7411
  • Fax:
Mailing address:
  • Phone: 201-510-0910
  • Fax: 201-621-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERRILL JORDAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 201-510-0910