Provider Demographics
NPI:1720018773
Name:PATHOLOGY & FORENSIC CONSULTANTS LLC
Entity Type:Organization
Organization Name:PATHOLOGY & FORENSIC CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-969-1950
Mailing Address - Street 1:PO BOX 10480
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46852
Mailing Address - Country:US
Mailing Address - Phone:260-969-1950
Mailing Address - Fax:260-918-2137
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802
Practice Address - Country:US
Practice Address - Phone:260-425-3762
Practice Address - Fax:260-425-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000487821OtherBCBS
IN200825690AMedicaid
OH2673790Medicaid
OH2673807Medicaid
INDF4174OtherRAILROAD MEDICARE
OH2673816Medicaid
OH2673790Medicaid