MEDICARE: AVINASH PASAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	2021-03294	NC
2	207RH0000X	Hematology (Internal Medicine) Physician	2021-03294	NC

General Provider Information

NPI Number	:	1750609582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVINASH PASAM MD

Provider Business Mailing Address
First Line	:	1638 OWEN DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3424
Country	:	US
Telephone Number	:	910-615-3840
Fax Number	:	910-321-6216

Provider Business Practice Location Address
First Line	:	6387 RAMSEY ST UNIT 140
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9442
Country	:	US
Telephone Number	:	910-615-3840
Fax Number	:	910-321-6216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	06/27/2024

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