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NPI Code Detail

MEDICARE: DR. GLEN ROY PINKSTON JR. M.D.

MEDICARE: DR. GLEN ROY PINKSTON JR. M.D.
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 Physician2011-00931NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
234437OTHERSCSTATE MEDICAL BOARD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42011-00931OTHERNCSTATE MEDICAL BOARD

General Provider Information

NPI Number : 1912904517
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLEN ROY PINKSTON JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 30637
Second Line :
City : CHARLOTTE
State : NC
Zip : 28230-0637
Country : US
Telephone Number : 704-973-5500
Fax Number : 704-973-5518
Provider Business Practice Location Address
First Line : 8800 N TRYON ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-3300
Country : US
Telephone Number : 704-863-5727
Fax Number : 704-863-5733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2005
Last Update Date : 04/17/2018

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