Basic Information
| Provider Information | |||||||||
| NPI: | 1285910315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WILLARD STREET | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021691281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174791452 | ||||||||
| FaxNumber: | 6177709491 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 SANDWICH STREET | ||||||||
| Address2: | CLUB CANCER CENTER | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023602401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174791452 | ||||||||
| FaxNumber: | 6177709491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2011 | ||||||||
| LastUpdateDate: | 11/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6174791452 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.