Organization
BLOOD & CANCER CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRISH D DEVASTHALI M.D. (PRESIDENT)
(910) 483-8586
Entity
Organization
Contact information
Practice address
1565 PURDUE DR, SUITE 301, FAYETTEVILLE, NC 28303-5536
(910) 483-8586
(910) 483-9212
Mailing address
PO BOX 53095, FAYETTEVILLE, NC 28305-3095
(910) 483-8586
(910) 483-9212
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
200401286
NC
207RH0003X
Hematology & Oncology Physician
Primary
38929
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011G3
BCBSNC
NC
05
—
89011G3
—
NC
Enumeration date
01/11/2007
Last updated
06/20/2013
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