Provider Demographics
NPI:1881682383
Name:EASTERN CAROLINA PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:EASTERN CAROLINA PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-234-2841
Mailing Address - Street 1:2693 FOREST HILLS RD SW STE B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8611
Mailing Address - Country:US
Mailing Address - Phone:252-234-2841
Mailing Address - Fax:252-234-9270
Practice Address - Street 1:2693 FOREST HILLS RD SW STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8611
Practice Address - Country:US
Practice Address - Phone:252-234-2841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7046195OtherMAMSI
22456OtherMEDCOST
NC890148JMedicaid
CL4298OtherRAILROAD MEDICARE
NC0148JOtherBCBS OF NC
22456OtherMEDCOST