NPIMap

Organization Active NPI

Community Cancer Care Specialists

  • Hematology & Oncology Physician
  • Mount Clemens, MI
National Provider Identifier
1760411680
Registry record updated Aug 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
009575 Issued in MI
Legal business name
COMMUNITY CANCER CARE SPECIALISTS
Practice address
1080 Harrington St
Suite 202
Mount Clemens, MI 48043-2901
Phone
(586) 493-3440
Fax
(586) 493-3445
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul M Derderian, D.O.
Title
Owner
Phone
(586) 493-3440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0003X 009575 MI Primary

Addresses

Primary practice location

1080 Harrington St
Suite 202
Mount Clemens, MI 48043-2901

Mailing address

PO Box 1169
Mount Clemens, MI 48046-1169
Phone (586) 493-3440

National Provider Directory

National Provider Directory

Locations

1030 Harrington St
Ste 301
Mount Clemens, MI 48043
Phone (586) 493-3440

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249430400000",
    "number": "1760411680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1169",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480461169",
            "telephone_number": "586-493-3440",
            "fax_number": "586-493-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 HARRINGTON ST",
            "address_2": "SUITE 202",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432901",
            "telephone_number": "586-493-3440",
            "fax_number": "586-493-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CANCER CARE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2009-08-05",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-493-3440",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "009575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.