Lake Cancer Medical Center PA

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

ME80262 Issued in FL

Legal business name

LAKE CANCER MEDICAL CENTER PA

Practice address

732 North Third Street
Leesburg, FL 34748

Phone

(352) 728-2532

Fax

(352) 728-3004

NPI assigned

Jul 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lourdes M Mathew, MD

Title

MD

Phone

(352) 728-2532

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313971200000",
    "number": "1093747560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 NORTH THIRD STREET",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "34748",
            "telephone_number": "352-728-2532",
            "fax_number": "352-728-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 NORTH THIRD STREET",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "34748",
            "telephone_number": "352-728-2532",
            "fax_number": "352-728-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CANCER MEDICAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-08-22",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "352-728-2532",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME81152",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "ME24875",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "ME80262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DE5747",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "94872",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer A Kyle, PTA
• Omar Lababidi, DMD
• Jeanne Ruelo Labasbas, P.T.
• Lake Arthritis Center P a
• Lake Cancer & Hematology PA
• Lake Center of H.O.P.E., PA
• Lake Centre Home Care LLC
• Lake Centre Home Care, LLC
• Lake County Anesthesia Associates PA
• Lake County Neurology, PA

• Hematology & Oncology Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Hematology & Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.