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General NPI Number Information
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NPI Number | 1376513515
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Entity Type | Organization
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Legal Business Name | ALLERGY CENTERS OF AMERICA LLC
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 190 CHARLOIS BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1522
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Country | US
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Telephone | 336-760-9838
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Fax | 336-760-5275
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Provider Business Mailing Address
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Address Line | 190 CHARLOIS BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1522
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Country | US
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Telephone | 336-760-9838
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Fax | 336-760-5275
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Authorized Official
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Title or Position | CEO
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Name | DR. DIMITRI PITOVSKI
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Credential | M.D.
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Telephone | 336-760-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | NC
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