Provider Demographics
NPI:1801862404
Name:PATHOLOGY ASSOCIATES OF SOUTHERN OH
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF SOUTHERN OH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHASHIKALA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-687-8141
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0550
Mailing Address - Country:US
Mailing Address - Phone:740-687-5164
Mailing Address - Fax:740-654-1417
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-7141
Practice Address - Fax:740-687-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039583Medicaid
OH2039583Medicaid
CF9490Medicare PIN