Organization
OUTER BANKS HEMATOLOGY ONCOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE M ACOSTAMADIEDO M.D. (PRESIDENT)
(252) 480-4699
Entity
Organization
Contact information
Practice address
4810 S CROATAN HWY, SUITE 120, NAGS HEAD, NC 27959-8508
(252) 480-4699
(252) 480-3280
Mailing address
PO BOX 2288, MANTEO, NC 27954-2288
(252) 480-4699
(252) 480-3280
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89126U6
—
NC
01
—
DE2252
RR MEDICARE
NC
Enumeration date
05/18/2006
Last updated
03/16/2010
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