Basic Information
| Provider Information | |||||||||
| NPI: | 1053305011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY ASSOCIATES OF KINSTON PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1295 | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247011295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043234320 | ||||||||
| FaxNumber: | 3043234333 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285011604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525227141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | HADDAD | ||||||||
| AuthorizedOfficialFirstName: | MICHEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2525227141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0269M | 01 | NC | BCBS OF NC | OTHER | 890269M | 05 | NC | MEDICAID | CC2915 | 01 | RAILROAD MEDICARE | OTHER |