Provider Demographics
NPI:1235126517
Name:CAROLINAS CANCER CARE PA
Entity Type:Organization
Organization Name:CAROLINAS CANCER CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WRAY
Authorized Official - Last Name:HAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-344-1995
Mailing Address - Street 1:411 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1066
Mailing Address - Country:US
Mailing Address - Phone:704-344-1995
Mailing Address - Fax:704-344-9125
Practice Address - Street 1:411 BILLINGSLEY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1066
Practice Address - Country:US
Practice Address - Phone:704-344-1995
Practice Address - Fax:704-344-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011V4Medicaid
NC2344591Medicare ID - Type Unspecified
NC89011V4Medicaid