Organization
L A LORENZO MD PATHOLOGY CONSULT SERVICES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALLISON WOOTEN (ACCOUNT REP)
(864) 223-3070
Entity
Organization
Contact information
Practice address
171 FAIRVIEW RD, MOORESVILLE, NC 28117-9500
(704) 660-4511
(704) 660-4903
Mailing address
PO BOX 49009, GREENWOOD, SC 29649-0001
(864) 223-3070
(864) 223-1396
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
23860
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34D0243371
CLIA REGISTRATION #
—
05
—
89014V3
—
NC
01
—
CL6158
RAILROAD MEDICARE
—
Enumeration date
04/11/2006
Last updated
01/08/2013
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