Provider Demographics
NPI:1477519148
Name:PATHOLOGISTS MEDICAL LABORATORY, P.A.
Entity Type:Organization
Organization Name:PATHOLOGISTS MEDICAL LABORATORY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-253-0762
Mailing Address - Street 1:PO BOX 17147
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-7147
Mailing Address - Country:US
Mailing Address - Phone:866-497-8328
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:10 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-253-0762
Practice Address - Fax:828-254-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2366OtherBCBS NC
NC8900303Medicaid
NC8900303Medicaid