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General NPI Number Information
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NPI Number | 1548615347
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Entity Type | Organization
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Legal Business Name | PREMIER HEMATOLOGY & TELE-ONCOLOGY CENTER, PLLC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 550 NEW WAVERLY PL STE 120
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City | CARY
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State | NC
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Zip | 27518-7412
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Country | US
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Telephone | 919-642-3738
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Fax | 919-585-1554
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Provider Business Mailing Address
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Address Line | 550 NEW WAVERLY PL SUITE 120
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City | CARY
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State | NC
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Zip | 27518-7412
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Country | US
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Telephone | 919-642-3738
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Fax | 919-585-1554
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIT R MEHTA
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Credential | M.D
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Telephone | 919-642-3738
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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 | 2010-00625
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License Number State | NC
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