Provider Demographics
NPI:1225245566
Name:BEAVER VALLEY PATHOLOGY, INC.
Entity Type:Organization
Organization Name:BEAVER VALLEY PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-773-4597
Mailing Address - Street 1:349 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1530
Mailing Address - Country:US
Mailing Address - Phone:412-741-8239
Mailing Address - Fax:
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187540207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty