Healthcare Provider Details

I. General information

NPI: 1780724690
Provider Name (Legal Business Name): NORTH CAROLINA RADIATION ONCOLOGY AFFILIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 HUFFMAN MILL RD SUITE 120
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

PO BOX 65595
CHARLOTTE NC
28265-0595
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-7725
  • Fax: 336-538-7785
Mailing address:
  • Phone: 336-538-7725
  • Fax: 336-538-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN S CHRYSTAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 336-538-7725