Provider Demographics
NPI:1558441998
Name:MONTGOMERY PATHOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:MONTGOMERY PATHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-285-3888
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:COOSADA
Mailing Address - State:AL
Mailing Address - Zip Code:36020-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 CEDAR DRIVE
Practice Address - Street 2:
Practice Address - City:COOSADA
Practice Address - State:AL
Practice Address - Zip Code:36020-0159
Practice Address - Country:US
Practice Address - Phone:334-285-3888
Practice Address - Fax:334-285-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD323Medicare ID - Type Unspecified