Provider Demographics
NPI:1265442800
Name:OUTPATIENT PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:OUTPATIENT PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-444-0889
Mailing Address - Street 1:7750 COLLEGE TOWN DR
Mailing Address - Street 2:102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2356
Mailing Address - Country:US
Mailing Address - Phone:916-444-0889
Mailing Address - Fax:916-444-6016
Practice Address - Street 1:7750 COLLEGE TOWN DR
Practice Address - Street 2:102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2356
Practice Address - Country:US
Practice Address - Phone:916-444-0889
Practice Address - Fax:916-444-6016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTPATIENT PATHOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF4818207ZC0500X, 207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029350Medicaid
CAGR0029350Medicaid