Healthcare Provider Details

I. General information

NPI: 1790602001
Provider Name (Legal Business Name): GREENSBORO PATHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E KINGS HWY
EDEN NC
27288-5201
US

IV. Provider business mailing address

1355 RIVER BEND DR
DALLAS TX
75247-4915
US

V. Phone/Fax

Practice location:
  • Phone: 336-387-2500
  • Fax:
Mailing address:
  • Phone: 954-803-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DINA VALLADARES
Title or Position: SR DIRECTOR
Credential:
Phone: 954-803-9405