Healthcare Provider Details

I. General information

NPI: 1578881116
Provider Name (Legal Business Name): REGIONAL CANCER CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3762 DURHAM RD
ROXBORO NC
27573-2741
US

IV. Provider business mailing address

PO BOX 601114
CHARLOTTE NC
28260-1114
US

V. Phone/Fax

Practice location:
  • Phone: 919-477-0047
  • Fax:
Mailing address:
  • Phone: 919-477-0047
  • Fax:

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: MR. THOMAS GRATES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-829-4450