Healthcare Provider Details

I. General information

NPI: 1477597615
Provider Name (Legal Business Name): RANDY A HOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HAWTHORNE LN SUITE 100
CHARLOTTE NC
28204-2450
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1900
  • Fax: 704-384-1919
Mailing address:
  • Phone: 704-384-1900
  • Fax: 704-384-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number01039910
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2009-01889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: