Provider Demographics
NPI:1659354678
Name:EDWARD J HARROW PTR, ALTON PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:EDWARD J HARROW PTR, ALTON PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-463-7410
Mailing Address - Street 1:PO BOX 952009
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2009
Mailing Address - Country:US
Mailing Address - Phone:314-821-8055
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7410
Practice Address - Fax:618-463-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055965207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4000429OtherAETNA
4000541OtherAETNA
117845OtherHEALTHLINK
111193OtherGHP
31740OtherGHP
45307OtherGHP
IL0006010035OtherBCBS
IL036055965Medicaid
100723OtherHEALTHLINK
CL3745OtherTRAVELERS
1107134OtherUHC
5241OtherADVANTRA/GHP
111193OtherGHP