Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 2009-00759 | NC |
N | 207RH0003X | Hematology & Oncology | G87657 | CA |
NPI | 1063469856 |
---|---|
Provider Name | Charles Samuel Kuzma |
First Address | Pinehurst, NC 28374-8798 |
Second Address | Pinehurst, NC 28374-8748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
153AT | BC/BS NC PROVIDER# (01) | |
FH2967790 | FIRSTCAROLINACARE PROVIDER# (01) | |
N0075K | SC MEDICAID PROVIDER# (01) | SC |