Lake Norman Hematology and Oncology Specialists PA

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

Legal business name

LAKE NORMAN HEMATOLOGY AND ONCOLOGY SPECIALISTS PA

Practice address

170 Medical Park Rd
Suite 101
Mooresville, NC 28117-8540

Phone

(704) 799-3946

Fax

(704) 799-3956

NPI assigned

Jun 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Krumdieck, M.D.

Title

President

Phone

(704) 799-3946

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1104854587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 101",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "704-799-3946",
            "fax_number": "704-799-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 101",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "704-799-3946",
            "fax_number": "704-799-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN HEMATOLOGY AND ONCOLOGY SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "KRUMDIECK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-799-3946",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "012AX",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012AX",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Mooresville, NC
• Hematology & Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.