Healthcare Provider Details

I. General information

NPI: 1275341760
Provider Name (Legal Business Name): PROSTATE CANCER INSTITUTE OF NORTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FIRST VILLAGE DR
PINEHURST NC
28374-9495
US

IV. Provider business mailing address

PO BOX 15088
PHOENIX AZ
85060-5088
US

V. Phone/Fax

Practice location:
  • Phone: 910-498-9246
  • Fax: 910-498-9247
Mailing address:
  • Phone: 910-498-9246
  • Fax: 910-498-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AJAY BHATNAGAR
Title or Position: OWNER
Credential: MD
Phone: 910-498-9246