NPIMap

Organization Active NPI

Carolina Specialty Oncology, PA

  • Urology Physician
  • Raleigh, NC
National Provider Identifier
1477520088
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CAROLINA SPECIALTY ONCOLOGY, PA
Practice address
117 Sunnybrook Rd
Raleigh, NC 27610-1827
Phone
(919) 334-3910
Fax
(919) 250-9280
NPI assigned
Mar 2, 2006
Reactivated
Mar 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

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

Authorized official

Name
Dr. Kevin P Khoudary, M.D.
Title
Director
Phone
(919) 334-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

117 Sunnybrook Rd
Raleigh, NC 27610-1827

Mailing address

117 Sunnybrook Rd
Raleigh, NC 27610-1827
Phone (919) 334-3910

Other identifiers 2

IdentifierTypeStateIssuer
5922273MedicaidNC
01708OtherNCBCBS

National Provider Directory

National Provider Directory

Locations

1904 S Main St
Ste 114
Wake Forest, NC 27587
Phone (919) 554-8539

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1477520088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 SUNNYBROOK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101827",
            "telephone_number": "919-334-3910",
            "fax_number": "919-250-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 SUNNYBROOK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101827",
            "telephone_number": "919-334-3910",
            "fax_number": "919-250-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA SPECIALTY ONCOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-02",
        "last_updated": "2015-12-09",
        "deactivation_date": "2006-03-02",
        "reactivation_date": "2006-03-07",
        "status": "A",
        "authorized_official_last_name": "KHOUDARY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-334-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5922273",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01708",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; 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.