Individual
DR. MARKANDU KETHEESWARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1209 CAPE CT, FAYETTEVILLE, NC 28304-4404
(910) 485-7003
(910) 485-7103
Mailing address
1209 CAPE CT, FAYETTEVILLE, NC 28304-4404
(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
—
891087E
—
NC
Enumeration date
05/20/2006
Last updated
05/25/2023
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