Provider Demographics
NPI:1356568059
Name:PATHOLOGY ASSOCIATES LABORATORIES, P.C.
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES LABORATORIES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-581-1200
Mailing Address - Street 1:23 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-581-1200
Mailing Address - Fax:410-581-1203
Practice Address - Street 1:23 CROSSROADS DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-581-1200
Practice Address - Fax:410-581-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD520291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW349Medicare ID - Type Unspecified