MEDICARE: PATHOLOGY ASSOCIATES II OF EASTERN NORTH CAROLINA PC

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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH2251	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0250T	OTHER	NC	BCBS OF NORTH CAROLINA

General Provider Information

NPI Number	:	1639163645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY ASSOCIATES II OF EASTERN NORTH CAROLINA PC

Provider Business Mailing Address
First Line	:	PO BOX 3391
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24115-3391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3353
Country	:	US
Telephone Number	:	252-335-0531
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. KENNETH R LAMM
Credential	:	MD
Telephone Number	:	252-335-0531

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	04/29/2008

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