Healthcare Provider Details

I. General information

NPI: 1497718100
Provider Name (Legal Business Name): PATHOLOGY ASSOCIATES OF BOONE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 DEERFIELD RD
BOONE NC
28607-5008
US

IV. Provider business mailing address

PO BOX 1867
BLUEFIELD WV
24701-5867
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34026
License Number StateNC

VIII. Authorized Official

Name: DR. BRENT DWAYE HALL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 828-262-4106