Healthcare Provider Details

I. General information

NPI: 1467406736
Provider Name (Legal Business Name): ONCOLOGY SPECIALISTS OF CHARLOTTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 RANDOLPH RD STE 400
CHARLOTTE NC
28207-2027
US

IV. Provider business mailing address

2711 RANDOLPH RD STE 400
CHARLOTTE NC
28207-2027
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-1900
  • Fax: 704-377-0353
Mailing address:
  • Phone: 704-342-1900
  • Fax: 704-377-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN P FAVARO
Title or Position: PARTNER
Credential: MD
Phone: 704-342-9550