Healthcare Provider Details

I. General information

NPI: 1720573132
Provider Name (Legal Business Name): MID-ATLANTIC ONCOLOGY HEMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 PLUM ORCHARD DR STE 211
SILVER SPRING MD
20904-7913
US

IV. Provider business mailing address

12210 PLUM ORCHARD DR STE 211
SILVER SPRING MD
20904-7913
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-3216
  • Fax:
Mailing address:
  • Phone: 301-933-3216
  • 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: KASHIF FIROZVI
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 301-933-3216