Basic Information
| Provider Information | |||||||||
| NPI: | 1275550931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEONE PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3628 | ||||||||
| Address2: | 1760 COUNTRY CLUB RD | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280540020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048668340 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 COURT DR | ||||||||
| Address2: | DEPT PATHOLOGY | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342851 | ||||||||
| FaxNumber: | 7048342815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEONE | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7048668340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 22769 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 890142V | 05 | NC | MEDICAID |