MEDICARE: NEWPORT PATHOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1265636542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT PATHOLOGY INC

Provider Business Mailing Address
First Line	:	1901 WESTCLIFF DR
Second Line	:	SUITE 5
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5598
Country	:	US
Telephone Number	:	252-548-9159
Fax Number	:

Provider Business Practice Location Address
First Line	:	1873 WEST ERINGHAUSE
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4555
Country	:	US
Telephone Number	:	252-548-9159
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENIS SAVENKO
Credential	:
Telephone Number	:	252-548-9159

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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