Provider Demographics
NPI:1467406736
Name:ONCOLOGY SPECIALISTS OF CHARLOTTE PA
Entity type:Organization
Organization Name:ONCOLOGY SPECIALISTS OF CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FAVARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-342-9550
Mailing Address - Street 1:2711 RANDOLPH RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-342-1900
Mailing Address - Fax:704-377-0353
Practice Address - Street 1:2711 RANDOLPH RD STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-342-1900
Practice Address - Fax:704-377-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02257OtherBCBSNC
CH1821OtherRR MEDICARE
NC8902257Medicaid
NC7348090001Medicare NSC
NC02257OtherBCBSNC