LAKE CANCER MEDICAL CENTER PA


Address: 732 North Third Street, Leesburg, FL 34748
Phone: 3527282532

LAKE CANCER MEDICAL CENTER PA (NPI# 1093747560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1093747560
Entity Type Organization
Organization Name LAKE CANCER MEDICAL CENTER PA
Practice Address 732 North Third Street
Leesburg
FL 34748
Practice Telephone 3527282532
Practice Fax Number 3527283004
Mailing Telephone 3527282532
Mailing Fax Number 3527283004
Enumeration Date 2006-07-07
Last Update Date 2011-08-22
Authorized Official Name MRS. LOURDES M MATHEW (MD)
Authorized Official Telephone 3527282532
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207RH0003X Internal Medicine
Specialization: Hematology & Oncology
ME24875 FL Allopathic & Osteopathic Physicians
N 174400000X Specialist ME81152 FL Other Service Providers
Y 207RH0003X Internal Medicine
Specialization: Hematology & Oncology
ME80262 FL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
FL BCBS 94872 01
FL RAILROAD MEDICARE DE5747 01

Office Location

Street Address 732 NORTH THIRD STREET
City LEESBURG
State FL
Zip Code 34748

Providers in the same location

NPI Name Taxonomy Address Enumeration
1033143912 Lourdes M Mathew Internal Medicine 732 North Third Street, Leesburg, FL 31748 2006-07-10

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1023480332 Juanita Elizabeth Simpson Contractor 1911 Harcourt Drive, Leesburg, FL 34748 2015-10-26
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Taxonomy Information

Taxonomy Code 207RH0003X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Hematology & Oncology

Taxonomy Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: http://www.osteopathic.org/certification

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1093339764 Loudoun Medical Group . P.c Internal Medicine 19500 Sandridge Way Ste 400, Leesburg, VA 20176-3691 2020-05-29
1881627966 Sandeep Kumar Thaper Internal Medicine 601 E Dixie Ave Ste 1001, Leesburg, FL 34748-7309 2006-07-09
1295716645 Rambabu Tummala Internal Medicine 9832 Us Hwy 441, Suite 101, Leesburg, FL 34788 2005-11-10
1275514622 Cancer Centers of Central Florida Pa Internal Medicine 9832 Us Highway 441, Ste 101, Leesburg, FL 34788-3966 2005-11-10
1356332506 Maen A Hussein Internal Medicine 110 North Boulevard East, Leesburg, FL 34748-5241 2005-11-04
1962499111 Christopher T Soprenuk Internal Medicine 9846 Us Highway 441, Leesburg, FL 34788-3910 2005-10-03
1184174336 Loudoun Medical Group . P.c Internal Medicine 44055 Riverside Pkwy, Suite 224, Leesburg, VA 20176-5179 2016-10-12
1306277793 Loudoun Medical Group PC Internal Medicine 44055 Riverside Pkwy, Suite 224, Leesburg, VA 20176-5179 2013-12-10
1699909093 Mei-hwa Rose Firestone Internal Medicine 19490 Sandridge Way Ste 240, Leesburg, VA 20176-3467 2009-05-13
1215006432 Central Florida Hematology and Oncology Internal Medicine 601 E Dixie Ave Ste 1001, Leesburg, FL 34748-7309 2006-11-06
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Competitor

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City LEESBURG
Zip Code 34748

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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