Provider Demographics
NPI:1063638005
Name:OHIO PATHOLOGY LABORATORIES INC
Entity Type:Organization
Organization Name:OHIO PATHOLOGY LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PLOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-393-9770
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-393-3455
Mailing Address - Fax:740-399-3134
Practice Address - Street 1:1330 COSHOCTON ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-9770
Practice Address - Fax:740-399-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059747207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785646Medicaid
E57713Medicare UPIN
OH9317272Medicare PIN
OH0785646Medicaid