Provider Demographics
NPI:1457532517
Name:COLUMBIA GORGE PATHOLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:COLUMBIA GORGE PATHOLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VASSIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIMAKTCHIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-296-7232
Mailing Address - Street 1:1700 E 19TH ST
Mailing Address - Street 2:PATHOLOGY
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3317
Mailing Address - Country:US
Mailing Address - Phone:541-296-7232
Mailing Address - Fax:541-296-7613
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:PATHOLOGY
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-7232
Practice Address - Fax:541-296-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR655735-87207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty