Individual
PAUL J KOSTUCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 WESTGATE CENTER DR STE B, WINSTON SALEM, NC 27103-3041
(336) 768-1280
(336) 760-8443
Mailing address
1351-B WESTGATE CENTER DR, WINSTON-SALEM, NC 27103-3041
(336) 768-1280
(336) 760-8444
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
200400056
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89136R2
—
NC
05
—
Q0005F
—
SC
Enumeration date
10/12/2005
Last updated
04/02/2009
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