Healthcare Provider Details

I. General information

NPI: 1821252115
Provider Name (Legal Business Name): ROSWELL PARK CANCER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROSWELL PARK CANCER INSTITUTE DEPT OF ELM & CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ROSWELL PARK CANCER INSTITUTE DEPARTMENT OF ELM & CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-7100
  • Fax:
Mailing address:
  • Phone: 716-845-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number241734
License Number StateNY

VIII. Authorized Official

Name: DR. CATHY QIUXI FAN
Title or Position: PATHOLOGIC ONCOLOGY FELLOW
Credential: M.D.
Phone: 716-845-7100