Healthcare Provider Details

I. General information

NPI: 1780928325
Provider Name (Legal Business Name): BALL DERMPATH, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 NEW GARDEN RD SUITE 106
GREENSBORO NC
27410-2566
US

IV. Provider business mailing address

2006 NEW GARDEN RD SUITE 106
GREENSBORO NC
27410-2566
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL BALL
Title or Position: OWNER/DERMATOPATHOLOGIST
Credential: M.D.
Phone: 336-609-6240