Provider Demographics
NPI:1649297417
Name:CAROLINA BIOONCOLOGY INSTITUTE, PLLC
Entity type:Organization
Organization Name:CAROLINA BIOONCOLOGY INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWDERLY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:704-947-6599
Mailing Address - Street 1:PO BOX 3547
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-3547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9801 KINCEY AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3110
Practice Address - Country:US
Practice Address - Phone:704-947-6599
Practice Address - Fax:704-947-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000939207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7435791OtherAETNA
NCE2701OtherMEDCOST
NC12618OtherBCBS
NC4859724OtherCIGNA
NC5912664Medicaid
NCDH0290Medicare PIN
NC5912664Medicaid
NC7435791OtherAETNA