Basic Information
Provider Information | |||||||||
NPI: | 1356311435 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PASCHOLD | ||||||||
FirstName: | EUGENE | ||||||||
MiddleName: | HENRY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 60516 | ||||||||
Address2: |   | ||||||||
City: | CHARLOTTE | ||||||||
State: | NC | ||||||||
PostalCode: | 282600516 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3362496632 | ||||||||
FaxNumber: | 3362497453 | ||||||||
Practice Location | |||||||||
Address1: | 3333 SILAS CREEK PKWY | ||||||||
Address2: |   | ||||||||
City: | WINSTON SALEM | ||||||||
State: | NC | ||||||||
PostalCode: | 271033013 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3362778800 | ||||||||
FaxNumber: | 3362778850 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2006 | ||||||||
LastUpdateDate: | 05/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 23637 | NC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 29080 | 01 |   | MEDCOST | OTHER | 3098200 | 01 |   | AETNA HMO | OTHER | 65760 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8965760 | 05 | NC |   | MEDICAID | 203 | 01 | NC | PARTNERS NATIONAL HEALTH | OTHER | 3603474 | 01 |   | UNITED HEALTHCARE | OTHER | 830008753 | 01 |   | RAILROAD MEDICARE | OTHER | 006005462 | 05 | VA |   | MEDICAID | 4098339 | 01 |   | AETNA PPO | OTHER |