MEDICARE: CAROLINAS CANCER CARE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21568	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235126517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS CANCER CARE PA

Provider Business Mailing Address
First Line	:	411 BILLINGSLEY RD
Second Line	:	SUITE 103
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-344-1995
Fax Number	:	704-344-9125

Provider Business Practice Location Address
First Line	:	411 BILLINGSLEY RD
Second Line	:	SUITE 103
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1066
Country	:	US
Telephone Number	:	704-344-1995
Fax Number	:	704-344-9125

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. THOMAS WRAY HAUCH
Credential	:	MD
Telephone Number	:	704-344-1995

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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1821071523 — CHARLES H. EDWARDS II MD
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1427022441 — DR. MYRON R TUCKER DDS
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1316911340 — DR. TODD E CROWLEY DDS
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1679547483 — DR. BRIAN B FARRELL DDS,MD
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1710954359 — ARISTIDES E CHACONAS MD
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Directions to “CAROLINAS CANCER CARE PA ” Practice Location

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