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NPI Code Detail

MEDICARE: KANAWHA PATHOLOGY ASSOCIATES INC

MEDICARE: KANAWHA PATHOLOGY ASSOCIATES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DA0748OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346249448
Entity Type Code : Organization
Provider Name (Legal Business Name) : KANAWHA PATHOLOGY ASSOCIATES INC
Provider Business Mailing Address
First Line : PO BOX 9129
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-0129
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3560
Fax Number :
Authorized Official
Title or Position : PRESIDENT/PATHOLOGIST
Name : DR. ROBERT M FULKS
Credential : MD
Telephone Number : 304-766-3560
Provider Enumeration Date : 07/20/2005
Last Update Date : 10/11/2007

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