Healthcare Provider Details

I. General information

NPI: 1164430757
Provider Name (Legal Business Name): HEMATOLOGY & ONCOLOGY ASSOCIATES OF GREENWICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LAFAYETTE PLACE
GREENWICH CT
06830
US

IV. Provider business mailing address

77 LAFAYETTE PLACE
GREENWICH CT
06830
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3737
  • Fax: 203-863-3741
Mailing address:
  • Phone: 203-863-3737
  • Fax: 203-863-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DICKERMAN HOLLISTER
Title or Position: PARTNER
Credential: MD
Phone: 203-863-3737