Provider Demographics
NPI:1598711301
Name:COMMONWEALTH HEMATOLOGYONCOLOGY PC
Entity Type:Organization
Organization Name:COMMONWEALTH HEMATOLOGYONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-479-1452
Mailing Address - Street 1:10 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1281
Mailing Address - Country:US
Mailing Address - Phone:617-479-1452
Mailing Address - Fax:617-479-3500
Practice Address - Street 1:10 WILLARD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1281
Practice Address - Country:US
Practice Address - Phone:617-479-1452
Practice Address - Fax:617-479-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACH6527OtherRAILROAD MEDICARE
MACC6604OtherRAILROAD MEDICARE
MAM21415Medicare PIN
MACH6527OtherRAILROAD MEDICARE