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Organization
CHARLESTON CANCER CENTER PA
Active
Organization
CHARLESTON CANCER CENTER PA
Active
Other names
Trident Palmetto Hematology Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS L. MICHAELSEN M.D. (MANAGING PARTNER)
(843) 572-9211
Entity
Organization
Contact information
Practice address
2910 TRICOM ST, NORTH CHARLESTON, SC 29406-9350
(843) 572-9211
(843) 572-0457
Mailing address
2910 TRICOM ST, NORTH CHARLESTON, SC 29406-9350
(843) 572-9211
(843) 572-0457
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
11628
SC
207RH0003X
Hematology & Oncology Physician
18607
SC
207RH0003X
Hematology & Oncology Physician
19684
SC
207RH0003X
Hematology & Oncology Physician
30018
SC
207RH0003X
Hematology & Oncology Physician
32155
SC
363A00000X
Physician Assistant
PA2273
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C612826292
MEDICARE GROUP NUMBER
—
Enumeration date
08/08/2006
Last updated
02/15/2016
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