Provider Demographics
NPI:1205026002
Name:PENNSYLVANIA SPECIALTY PATHOLOGY LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA SPECIALTY PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-368-4740
Mailing Address - Street 1:2301 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2415
Mailing Address - Country:US
Mailing Address - Phone:717-393-7771
Mailing Address - Fax:717-393-7328
Practice Address - Street 1:2301 HARRISBURG PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2415
Practice Address - Country:US
Practice Address - Phone:717-393-7771
Practice Address - Fax:717-393-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120165Medicare PIN