Provider Demographics
NPI:1356385843
Name:WILMINGTON PATHOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:WILMINGTON PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-362-9511
Mailing Address - Street 1:PO BOX 99588
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9588
Mailing Address - Country:US
Mailing Address - Phone:919-420-7811
Mailing Address - Fax:919-420-7815
Practice Address - Street 1:1915 S 17TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6626
Practice Address - Country:US
Practice Address - Phone:910-362-9511
Practice Address - Fax:910-362-0277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILMINGTON PATHOLOGY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2552652AMedicare PIN