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General NPI Number Information
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NPI Number | 1003883877
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Entity Type | Organization
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Legal Business Name | PATHOLOGISTS DIAGNOSTIC LABORATORY PA
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1800 S HAWTHORNE RD STE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4014
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Country | US
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Telephone | 336-999-8888
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Fax | 336-999-8889
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Provider Business Mailing Address
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Address Line | PO BOX 896315
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City | CHARLOTTE
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State | NC
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Zip | 28289-0369
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Country | US
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Telephone | 336-999-8888
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Fax | 369-999-8889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CULLEN A TAYLOR
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Credential |
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Telephone | 336-999-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 22288
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License Number State | NC
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