Provider Demographics
NPI:1700976628
Name:INDEPENDENT HEMATOLOGY AND ONCOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:INDEPENDENT HEMATOLOGY AND ONCOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:919-233-8585
Mailing Address - Street 1:300 ASHVILLE AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-8682
Mailing Address - Country:US
Mailing Address - Phone:919-233-8585
Mailing Address - Fax:919-233-8566
Practice Address - Street 1:300 ASHVILLE AVE
Practice Address - Street 2:STE 310
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8682
Practice Address - Country:US
Practice Address - Phone:919-233-8585
Practice Address - Fax:919-233-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016H4Medicaid
NCD25078Medicare UPIN
NC89016H4Medicaid