MEDICARE: GOLDSBORO PATHOLOGY SERVICES 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	C31250	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0239C	OTHER	NC	BCBS
2	23961	OTHER		MEDCOST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912983081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDSBORO PATHOLOGY SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 5468
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24115-5468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9494
Country	:	US
Telephone Number	:	919-731-6012
Fax Number	:	919-731-6616

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES A. DANIELS
Credential	:	MD
Telephone Number	:	919-731-6012

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/12/2007

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Directions to “GOLDSBORO PATHOLOGY SERVICES INC ” Practice Location

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