Healthcare Provider Details

I. General information

NPI: 1376519512
Provider Name (Legal Business Name): CRAVEN PATHOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

PO BOX 100559
FLORENCE SC
29501-0559
US

V. Phone/Fax

Practice location:
  • Phone: 252-637-9298
  • Fax: 252-633-8941
Mailing address:
  • Phone: 843-664-4300
  • Fax: 843-664-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number36652
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number30691
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number36652
License Number StateNC

VIII. Authorized Official

Name: DR. KEITH WILKINSON BENNERT
Title or Position: PRESIDENT
Credential: MD
Phone: 252-633-8069