Healthcare Provider Details

I. General information

NPI: 1841281664
Provider Name (Legal Business Name): CONSULTANTS IN PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRIDGE ST STE A
WILKESBORO NC
28697-2488
US

IV. Provider business mailing address

PO BOX 1239
WILKESBORO NC
28697-1239
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-9550
  • Fax:
Mailing address:
  • Phone: 336-838-9550
  • Fax: 336-838-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number36016
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number36016
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number36016
License Number StateNC

VIII. Authorized Official

Name: DR. WENDELL LEWIS RANDALL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 336-838-9550