Provider Demographics
NPI:1336447655
Name:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Entity Type:Organization
Organization Name:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Other - Org Name:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC-CARNEY FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:617-770-9491
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:SUITE 3310
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-1265
Practice Address - Fax:617-296-0112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty