Healthcare Provider Details

I. General information

NPI: 1205680048
Provider Name (Legal Business Name): RCCA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

22616 GATEWAY CENTER DR STE C
CLARKSBURG MD
20871-2011
US

IV. Provider business mailing address

500 FRANK W BURR BLVD STE 560
TEANECK NJ
07666-6804
US

V. Phone/Fax

Practice location:
  • Phone: 301-685-6300
  • Fax:
Mailing address:
  • Phone: 201-621-6931
  • Fax:

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