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General NPI Number Information
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NPI Number | 1437424975
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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 | 03/16/2012
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 630 BROOKWOOD BUSINESS PARK DR
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City | WINSTON SALEM
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State | NC
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Zip | 27105-4478
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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 30369
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City | WINSTON SALEM
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State | NC
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Zip | 27130-0369
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Country | US
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Telephone | 369-998-8883
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Fax | 369-998-8889
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Authorized Official
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Title or Position | CLIENT SERVICES MANAGER
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Name | MRS. CARLA N SMITH
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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