Basic Information
| Provider Information | |||||||||
| NPI: | 1356385843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMINGTON PATHOLOGY ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99588 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276249588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194207811 | ||||||||
| FaxNumber: | 9194207815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 S 17TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103629511 | ||||||||
| FaxNumber: | 9103620277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHIRO | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9103629511 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WILMINGTON PATHOLOGY ASSOCIATES PA | ||||||||
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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 |
No ID Information.