MEDICARE: NORTHERN CALIFORNIA HEMATOLOGY AND ONCOLOGY CONSULTANTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043208457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN CALIFORNIA HEMATOLOGY AND ONCOLOGY CONSULTANTS, INC

Provider Business Mailing Address
First Line	:	2001 DWIGHT WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2608
Country	:	US
Telephone Number	:	510-204-6402
Fax Number	:	510-848-0801

Provider Business Practice Location Address
First Line	:	2001 DWIGHT WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2608
Country	:	US
Telephone Number	:	510-204-6402
Fax Number	:	510-848-0801

Authorized Official
Title or Position	:	MD/EXECUTIVE DIRECTOR
Name	:	DR. GARY CECCHI
Credential	:	M.D.
Telephone Number	:	510-204-6402

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	11/08/2019

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