Kostuchenko, Paul J

Kostuchenko, Paul J is an individual health care provider with primary practice located at 1345 Westgate Center Dr Ste B , Winston Salem NC 27103-3041. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatopathology, which is considered as his primary health care specialty. Kostuchenko, Paul J can be contacted via phone (336) 768-1280.

Contact Information

Primary practice address
1345 Westgate Center Dr Ste B Winston Salem NC 27103-3041
Phone: (336) 768-1280
Fax: (336) 760-8443
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 200400056 North Carolina

Profile Details

NPI number 1972591055
LBN Legal business name Kostuchenko, Paul J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2005
Last updated Apr 2nd, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972591055 NPPES
South Carolina MEDICAID Q0005F
South Carolina MEDICAID 89136R2

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