Basic Information
| Provider Information | |||||||||
| NPI: | 1760584130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHISM | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | BARRETT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NORTH SHORE HEALTH SYSTEMS | ||||||||
| Address2: | 81 HIGHLAND AVE | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783544173 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 CENTENNIAL DR RADIATION ONCOLOGY | ||||||||
| Address2: | |||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789779400 | ||||||||
| FaxNumber: | 9785380341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 220136 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.