Provider Demographics
NPI:1760584130
Name:CHISM, DEREK BARRETT (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:BARRETT
Last Name:CHISM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:NORTH SHORE HEALTH SYSTEMS
Mailing Address - Street 2:81 HIGHLAND AVE
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-354-4173
Mailing Address - Fax:
Practice Address - Street 1:17 CENTENNIAL DR RADIATION ONCOLOGY
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-977-9400
Practice Address - Fax:978-538-0341
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA2201362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology