Provider Demographics
NPI:1639163645
Name:PATHOLOGY ASSOCIATES II OF EASTERN NORTH CAROLINA PC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES II OF EASTERN NORTH CAROLINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-335-0531
Mailing Address - Street 1:PO BOX 3391
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-3391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1144 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3353
Practice Address - Country:US
Practice Address - Phone:252-335-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH2251OtherRAILROAD MEDICARE
NC79012VCMedicaid
NC0250TOtherBCBS OF NORTH CAROLINA
CH2251OtherRAILROAD MEDICARE
NC79012VCMedicaid