Provider Demographics
NPI:1689628158
Name:CAROLINAS PATHOLOGY GROUP, PA
Entity Type:Organization
Organization Name:CAROLINAS PATHOLOGY GROUP, PA
Other - Org Name:CAROLINAS PATHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIVASY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-973-5500
Mailing Address - Street 1:PO BOX 30637
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0637
Mailing Address - Country:US
Mailing Address - Phone:704-973-5500
Mailing Address - Fax:704-973-5518
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-973-5500
Practice Address - Fax:704-973-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901281Medicaid
NC8901281Medicaid