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General NPI Number Information
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NPI Number | 1619426897
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA HEMATOLOGY ONCOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 2991 CROUSE LN
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-763-4428
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Fax | 336-763-4440
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Provider Business Mailing Address
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Address Line | 2991 CROUSE LN
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City | BURLINGTON
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State | NC
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Zip | 27215-8833
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Country | US
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Telephone | 336-763-4428
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Fax | 336-763-4440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KALSOOM KAUSAR KHAN
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Credential | M.D.
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Telephone | 336-380-5327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 200401242
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License Number State | NC
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