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General NPI Number Information
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NPI Number | 1104854587
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN HEMATOLOGY AND ONCOLOGY SPECIALISTS PA
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 170 MEDICAL PARK RD SUITE 101
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City | MOORESVILLE
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State | NC
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Zip | 28117-8540
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Country | US
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Telephone | 704-799-3946
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Fax | 704-799-3956
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Provider Business Mailing Address
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Address Line | 170 MEDICAL PARK RD SUITE 101
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City | MOORESVILLE
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State | NC
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Zip | 28117-8540
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Country | US
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Telephone | 704-799-3946
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Fax | 704-799-3956
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD KRUMDIECK
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Credential | M.D.
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Telephone | 704-799-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | NC
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