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General NPI Number Information
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NPI Number | 1831403625
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Entity Type | Organization
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Legal Business Name | THE CANCER CENTER AT GAITHERSBURG,LLC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 808 WEST DIAMOND AVE.
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City | GAITHERSBURG
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State | MD
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Zip | 20878
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Country | US
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Telephone | 703-934-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 808 WEST DIAMOND AVE.
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City | GAITHERSBURG
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State | MD
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Zip | 20878
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Country | US
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Telephone | 703-934-4450
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANU GUPTA
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Credential | M.D.
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Telephone | 703-934-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0048205
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License Number State | MD
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