Provider Demographics
NPI:1164430757
Name:HEMATOLOGY & ONCOLOGY ASSOCIATES OF GREENWICH
Entity Type:Organization
Organization Name:HEMATOLOGY & ONCOLOGY ASSOCIATES OF GREENWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DICKERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-863-3737
Mailing Address - Street 1:77 LAFAYETTE PLACE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-863-3737
Mailing Address - Fax:203-863-3741
Practice Address - Street 1:77 LAFAYETTE PLACE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-863-3737
Practice Address - Fax:203-863-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000244OtherMEDICARE PTAN
CT004253910Medicaid