Healthcare Provider Details

I. General information

NPI: 1225020944
Provider Name (Legal Business Name): NORTH STAR PATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S MAIN ST
REIDSVILLE NC
27320-5020
US

IV. Provider business mailing address

PO BOX 3391
MARTINSVILLE VA
24115-3391
US

V. Phone/Fax

Practice location:
  • Phone: 336-951-4551
  • Fax: 336-951-4909
Mailing address:
  • Phone: 276-670-2400
  • Fax: 276-670-2406

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. HUGH E FRASER III
Title or Position: PRESIDENT
Credential: MD
Phone: 336-951-4551