Healthcare Provider Details

I. General information

NPI: 1447922083
Provider Name (Legal Business Name): REDEEMER CANCER CARE PHYSICIANS NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 HUNTINGDON PIKE
MEADOWBROOK PA
19046-8001
US

IV. Provider business mailing address

667 WELSH RD
HUNTINGDON VALLEY PA
19006-6309
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-4682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA MARTIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 215-938-4682