Organization
WILMINGTON PATHOLOGY LABORATORY INC
Active
Organization
WILMINGTON PATHOLOGY LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN C SHIRO (PRESIDENT)
(910) 362-9511
Entity
Organization
Contact information
Practice address
1915 S 17TH ST, SUITE 100, WILMINGTON, NC 28401-6683
(910) 362-9511
Mailing address
PO BOX 20169, ROANOKE, VA 24018-0506
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018F3
BCBS OF NORTH CAROLINA
NC
05
—
7001334
—
NC
01
—
P00627249
RAILROAD MEDICARE
—
Enumeration date
11/13/2007
Last updated
12/15/2008
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