Provider Demographics
NPI:1912904517
Name:PINKSTON, GLEN ROY JR (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ROY
Last Name:PINKSTON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 30637
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0637
Mailing Address - Country:US
Mailing Address - Phone:704-973-5500
Mailing Address - Fax:704-973-5518
Practice Address - Street 1:8800 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3300
Practice Address - Country:US
Practice Address - Phone:704-863-5727
Practice Address - Fax:704-863-5733
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2018-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2011-00931207ZP0102X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1429Medicaid
SC34437OtherSTATE MEDICAL BOARD
NC5917687Medicaid
NC2011-00931OtherSTATE MEDICAL BOARD
AL000081388Medicaid
AL051081388OtherBCBS