Provider Demographics
NPI:1447235205
Name:TRISTAR PATHOLOGY LLC
Entity Type:Organization
Organization Name:TRISTAR PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-786-6816
Mailing Address - Street 1:PO BOX 1461
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-8961
Mailing Address - Country:US
Mailing Address - Phone:518-786-6816
Mailing Address - Fax:518-786-1293
Practice Address - Street 1:2210 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4725
Practice Address - Country:US
Practice Address - Phone:518-786-6816
Practice Address - Fax:518-786-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1138Medicare ID - Type Unspecified