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
207RH0003X
Hematology & Oncology Physician
—
—
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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