1396701660 NPI number — KINGSLEY LANE PATHOLOGY ASSOCIATES PC

Table of content: (NPI 1396701660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396701660 NPI number — KINGSLEY LANE PATHOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGSLEY LANE PATHOLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396701660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 758994
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-6412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-353-0788
Provider Business Mailing Address Fax Number:
804-355-6031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 KINGSLEY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-889-5069
Provider Business Practice Location Address Fax Number:
804-355-6031
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGER
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP ATTENDING PATHOLOGIST
Authorized Official Telephone Number:
757-889-5069

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 890158J , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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