Provider Demographics
NPI:1700874120
Name:EASTBAY HEMATOLOGY/ONCOLOGY CONSULTANTS, INC
Entity Type:Organization
Organization Name:EASTBAY HEMATOLOGY/ONCOLOGY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-204-6024
Mailing Address - Street 1:2001 DWIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-204-6402
Mailing Address - Fax:510-848-0801
Practice Address - Street 1:2000 VALE RD
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3808
Practice Address - Country:US
Practice Address - Phone:510-204-6402
Practice Address - Fax:510-848-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101090Medicaid
CAZZZ01791ZMedicare PIN