Provider Demographics
NPI:1598113870
Name:WYOMING VALLEY PATHOLOGY LLC
Entity Type:Organization
Organization Name:WYOMING VALLEY PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-552-1435
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0205
Mailing Address - Country:US
Mailing Address - Phone:570-208-5525
Mailing Address - Fax:570-208-5556
Practice Address - Street 1:300 LAIRD ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7020
Practice Address - Country:US
Practice Address - Phone:570-829-8111
Practice Address - Fax:570-208-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39D2118978OtherCLIA