Provider Demographics
NPI:1649873647
Name:MARLBORO CHESTERFIELD PATHOLOGY, PC
Entity type:Organization
Organization Name:MARLBORO CHESTERFIELD PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-687-4189
Mailing Address - Street 1:PO BOX 4270
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4270
Mailing Address - Country:US
Mailing Address - Phone:910-687-4189
Mailing Address - Fax:910-235-0171
Practice Address - Street 1:30 PAGE ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7928
Practice Address - Country:US
Practice Address - Phone:910-687-4188
Practice Address - Fax:910-235-0171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARLBORO CHESTERFIELD PATHOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC42D0713042OtherCLIA NUMBER