Basic Information
| Provider Information | |||||||||
| NPI: | 1881682383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN CAROLINA PATHOLOGY ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2693 FOREST HILLS RD SW STE B | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278938611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522342841 | ||||||||
| FaxNumber: | 2522349270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2693 FOREST HILLS RD SW STE B | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278938611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522342841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | COULTER | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2522342841 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/03/2020 | ||||||||
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 | 7046195 | 01 | MAMSI | OTHER | 22456 | 01 | MEDCOST | OTHER | 890148J | 05 | NC | MEDICAID | CL4298 | 01 | RAILROAD MEDICARE | OTHER | 0148J | 01 | NC | BCBS OF NC | OTHER |