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General NPI Number Information
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NPI Number | 1871658443
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Entity Type | Organization
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Legal Business Name | WAVERLY HEMATOLOGY ONCOLOGY PA
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 300 ASHVILLE AVE SUITE 310
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City | CARY
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State | NC
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Zip | 27518-8682
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Country | US
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Telephone | 919-233-8585
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Fax | 919-233-8566
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Provider Business Mailing Address
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Address Line | 300 ASHVILLE AVE SUITE 310
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City | CARY
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State | NC
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Zip | 27518-8682
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Country | US
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Telephone | 919-233-8585
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Fax | 919-233-8566
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARK GRAHAM II
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Credential | MD
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Telephone | 919-233-8585
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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 | 39812
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License Number State | NC
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