Provider Demographics
NPI:1245446905
Name:PIEDMONT HEM ONC ASSOCIATES
Entity type:Organization
Organization Name:PIEDMONT HEM ONC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRYSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-277-8800
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28201-1243
Mailing Address - Country:US
Mailing Address - Phone:919-425-6398
Mailing Address - Fax:919-425-6959
Practice Address - Street 1:1010 BETHESDA CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3019
Practice Address - Country:US
Practice Address - Phone:336-277-8864
Practice Address - Fax:336-277-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
NC109933336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3410824OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5903970001Medicare NSC