Healthcare Provider Details

I. General information

NPI: 1558695288
Provider Name (Legal Business Name): ECU PHYSICIANS DIAGNOSTIC PATHOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD 642 PATH AND LAB MEDICINE
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

PO BOX 602343
CHARLOTTE NC
28260-2343
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3748
  • Fax:
Mailing address:
  • Phone: 800-831-8402
  • 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: DR. PETER J KRAGEL
Title or Position: CHAIRMAN, DEPT OF PATH AND LAB MED
Credential: MD
Phone: 252-847-4951