Basic Information
| Provider Information | |||||||||
| NPI: | 1598711301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMONWEALTH HEMATOLOGYONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021691281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174791452 | ||||||||
| FaxNumber: | 6174793500 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021691281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174791452 | ||||||||
| FaxNumber: | 6174793500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6174791452 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CH6527 | 01 | MA | RAILROAD MEDICARE | OTHER | CC6604 | 01 | MA | RAILROAD MEDICARE | OTHER |