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General NPI Number Information
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NPI Number | 1821252115
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Entity Type | Organization
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Legal Business Name | ROSWELL PARK CANCER INSTITUTE
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | ROSWELL PARK CANCER INSTITUTE DEPT OF ELM & CARLTON STREETS
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City | BUFFALO
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State | NY
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Zip | 14263-0001
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Country | US
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Telephone | 716-845-7100
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Fax |
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Provider Business Mailing Address
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Address Line | ROSWELL PARK CANCER INSTITUTE DEPARTMENT OF ELM & CARLTON STREETS
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City | BUFFALO
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State | NY
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Zip | 14263-0001
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Country | US
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Telephone | 716-845-7100
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Fax |
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Authorized Official
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Title or Position | PATHOLOGIC ONCOLOGY FELLOW
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Name | DR. CATHY QIUXI FAN
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Credential | M.D.
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Telephone | 716-845-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 241734
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License Number State | NY
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