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NPI Code Detail

MEDICARE: PATHOLOGISTS DIAGNOSTIC LABORATORY PA

MEDICARE: PATHOLOGISTS DIAGNOSTIC LABORATORY PA
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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437424975
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHOLOGISTS DIAGNOSTIC LABORATORY PA
Provider Business Mailing Address
First Line : PO BOX 30369
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27130-0369
Country : US
Telephone Number : 369-998-8883
Fax Number : 369-998-8889
Provider Business Practice Location Address
First Line : 630 BROOKWOOD BUSINESS PARK DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27105-4478
Country : US
Telephone Number : 336-999-8888
Fax Number : 336-999-8889
Authorized Official
Title or Position : CLIENT SERVICES MANAGER
Name : MRS. CARLA N SMITH
Credential :
Telephone Number : 336-999-8888
Provider Enumeration Date : 03/16/2012
Last Update Date : 11/24/2020

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Directions to “PATHOLOGISTS DIAGNOSTIC LABORATORY PA ” Practice Location

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