Provider Demographics
NPI:1528022126
Name:HEMATOLOGY & ONCOLOGY ASSOCIATES OF FAYETTEVILLE, P.A.
Entity Type:Organization
Organization Name:HEMATOLOGY & ONCOLOGY ASSOCIATES OF FAYETTEVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:MANUBHAI
Authorized Official - Last Name:BAKRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-615-6914
Mailing Address - Street 1:PO BOX 42935
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-2935
Mailing Address - Country:US
Mailing Address - Phone:910-615-6910
Mailing Address - Fax:910-615-5219
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-6910
Practice Address - Fax:910-615-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900923207RH0003X
NC26183207RX0202X
NC32779207RX0202X
NC200943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890239QMedicaid
NC2323374Medicare ID - Type Unspecified