Organization
TRINITY HEMATOLOGY & ONCOLOGY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK KETHEESWARAN MD (ATTENDING PHYSICIAN)
(910) 485-7003
Entity
Organization
Contact information
Practice address
1209 CAPE CT, FAYETTEVILLE, NC 28304-4404
(910) 485-7003
(910) 485-7103
Mailing address
PO BOX 87427, FAYETTEVILLE, NC 28304-7427
(910) 485-7003
(910) 485-7103
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
9701004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01814
BLUE CROSS & BLUE SHIELD
NC
05
—
7901814
—
NC
Enumeration date
06/23/2005
Last updated
03/05/2010
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