1962464347 NPI number — MEDICAL ONCOLOGY & HEMATOLOGY, P.C.

Table of content: (NPI 1962464347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962464347 NPI number — MEDICAL ONCOLOGY & HEMATOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ONCOLOGY & HEMATOLOGY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962464347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 QUINCY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02302-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-586-1410
Provider Business Mailing Address Fax Number:
508-427-1730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 QUINCY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-2864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-586-1410
Provider Business Practice Location Address Fax Number:
508-427-1730
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUIFFO
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-586-1410

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00000005582 . This is a "BMC GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011328 . This is a "NEIGHBORHOOD HEALTH GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600338 . This is a "SECURE HORIZONS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CL6573 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9717196 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M12838 . This is a "BC 65 GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600034 . This is a "HPHC GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600338 . This is a "TUFTS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M12838 . This is a "BLUE SHIELD GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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