Provider Demographics
NPI:1568509727
Name:PALO ALTO PATHOLOGY, INC
Entity Type:Organization
Organization Name:PALO ALTO PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-617-1849
Mailing Address - Street 1:2325 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1620
Mailing Address - Country:US
Mailing Address - Phone:650-617-1849
Mailing Address - Fax:650-327-2234
Practice Address - Street 1:2325 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1620
Practice Address - Country:US
Practice Address - Phone:650-617-1849
Practice Address - Fax:650-327-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206746291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03522ZMedicaid
CAZZZ03522ZMedicare Oscar/Certification
CAZZZ03522ZMedicare UPIN
CAZZZ03522ZMedicare PIN