Provider Demographics
NPI:1285910315
Name:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Entity type:Organization
Organization Name:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
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 STREET
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 1:275 SANDWICH STREET
Practice Address - Street 2:CLUB CANCER CENTER
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2401
Practice Address - Country:US
Practice Address - Phone:617-479-1452
Practice Address - Fax:617-770-9491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty