1700976628 NPI number — INDEPENDENT HEMATOLOGY AND ONCOLOGY ASSOCIATES, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700976628 NPI number — INDEPENDENT HEMATOLOGY AND ONCOLOGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT HEMATOLOGY AND ONCOLOGY ASSOCIATES, P.A.
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:
1700976628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 ASHVILLE AVE
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-8682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-233-8585
Provider Business Mailing Address Fax Number:
919-233-8566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 ASHVILLE AVE
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518-8682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-233-8585
Provider Business Practice Location Address Fax Number:
919-233-8566
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
MARK
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
919-233-8585

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: 89016H4 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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