Provider Demographics
NPI:1881841856
Name:CUTANEOUS PATHOLOGY, P.A.
Entity Type:Organization
Organization Name:CUTANEOUS PATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:PASTOR
Authorized Official - Last Name:SANGUEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-1388
Mailing Address - Street 1:PO BOX 63333
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3333
Mailing Address - Country:US
Mailing Address - Phone:336-760-1388
Mailing Address - Fax:336-760-1398
Practice Address - Street 1:1800 S HAWTHORNE RD STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4014
Practice Address - Country:US
Practice Address - Phone:336-760-1388
Practice Address - Fax:336-760-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138498207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950703Medicaid
SCQPB748Medicaid
NCDO9951 - RRMedicare PIN
NC2209616FMedicare PIN