Healthcare Provider Details

I. General information

NPI: 1467800367
Provider Name (Legal Business Name): RCCA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR STE 327
OLNEY MD
20832-1507
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: 301-570-0136
  • Fax:
Mailing address:
  • Phone: 201-510-0900
  • 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