34D2275347 CLIA NUMBER - NOVANT HEALTH CANCER INSTITUTE - WILKESBORO

Laboratory Demographics

CLIA Number: 34D2275347

Facility Name: NOVANT HEALTH CANCER INSTITUTE - WILKESBORO

Facility Address:
1919 WEST PARK DRIVE
N WILKESBORO, NC
ZIP 28659
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Facility Phone Number: 336 903-6362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1538478813

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	34D2275347
LAB Type	Physician Office
Facility Name	NOVANT HEALTH CANCER INSTITUTE - WILKESBORO
Street	1919 WEST PARK DRIVE
City	N WILKESBORO
State	NC
ZIP	28659
Phone	336 903-6362
CertificateType	4
CertificateEffectiveDate	1/19/2023
CertificateExpirationDate	1/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024