=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043399835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE JEANETTE FIELDS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 01/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4380 FEDERAL DR SUITE1
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-8148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-315-6270
-----------------------------------------------------
Fax | 336-235-0435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4380 FEDERAL DR SUITE1
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-8148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-315-6270
-----------------------------------------------------
Fax | 336-235-0435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | ME74518
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------