Healthcare Provider Details

I. General information

NPI: 1407968696
Provider Name (Legal Business Name): AMOL ASHOK BAHEKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST STE 301 FAYETTEVILLE HEART CENTER PC
FAYETTEVILLE NC
28305-5641
US

IV. Provider business mailing address

2301 ROBESON ST STE 301 FAYETTEVILLE HEART CENTER PC
FAYETTEVILLE NC
28305-5641
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4100
  • Fax: 910-484-4179
Mailing address:
  • Phone: 910-484-4100
  • Fax: 910-484-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.205342
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22531
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2013-01748
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.120194
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2013-01748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: