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General NPI Number Information
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NPI Number | 1558695288
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Entity Type | Organization
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Legal Business Name | ECU PHYSICIANS DIAGNOSTIC PATHOLOGY SERVICES
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 600 MOYE BLVD 642 PATH AND LAB MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-4300
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Country | US
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Telephone | 252-744-3748
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 602343
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City | CHARLOTTE
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State | NC
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Zip | 28260-2343
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Country | US
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Telephone | 800-831-8402
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN, DEPT OF PATH AND LAB MED
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Name | DR. PETER J KRAGEL
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Credential | MD
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Telephone | 252-847-4951
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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 |
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License Number State |
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