Provider Demographics
NPI:1245591965
Name:NORTH SHORE PATHOLOGY LLC
Entity Type:Organization
Organization Name:NORTH SHORE PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-250-7698
Mailing Address - Street 1:850 COLUMBIA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7215
Mailing Address - Country:US
Mailing Address - Phone:440-808-1212
Mailing Address - Fax:440-808-0321
Practice Address - Street 1:850 COLUMBIA RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7215
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:440-808-2060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE GASTROENTEROLOGY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0336065207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHEC9199OtherMEDICARE RAILROAD