Healthcare Provider Details

I. General information

NPI: 1396728291
Provider Name (Legal Business Name): VIKTOR N GONCHARUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 NEW GARDEN RD
GREENSBORO NC
27410-2566
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 336-609-6240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2026-00030
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2026-00030
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: