Provider Demographics
NPI:1558695288
Name:ECU PHYSICIANS DIAGNOSTIC PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:ECU PHYSICIANS DIAGNOSTIC PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, DEPT OF PATH AND LAB MED
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-847-4951
Mailing Address - Street 1:PO BOX 602343
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2343
Mailing Address - Country:US
Mailing Address - Phone:800-831-8402
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:642 PATH AND LAB MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty