Basic Information
| Provider Information | |||||||||
| NPI: | 1902026180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASHIST | ||||||||
| FirstName: | PRAVEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 6TH AVE W | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286928045 | ||||||||
| FaxNumber: | 8286926630 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 DOCTORS DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286540073 | ||||||||
| FaxNumber: | 8286815036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301083453 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 2012-00998 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 2012-00998 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | P01083724 | 01 | NC | RAILROAD MEDICARE | OTHER | 5920576 | 05 | NC | MEDICAID | 9688868 | 01 | NC | CIGNA | OTHER | 9911096 | 01 | NC | AETNA | OTHER | 173Y5 | 01 | NC | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | OTHER |