Healthcare Provider Details

I. General information

NPI: 1285910315
Provider Name (Legal Business Name): COMMONWEALTH HEMATOLOGY-ONCOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH STREET CLUB CANCER CENTER
PLYMOUTH MA
02360-2401
US

IV. Provider business mailing address

10 WILLARD STREET
QUINCY MA
02169-1281
US

V. Phone/Fax

Practice location:
  • Phone: 617-479-1452
  • Fax: 617-770-9491
Mailing address:
  • Phone: 617-479-1452
  • Fax: 617-770-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. MICHAEL J ANDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 617-479-1452