Provider Demographics
NPI:1720056294
Name:TRILLIUM PATHOLOGY, INC.
Entity Type:Organization
Organization Name:TRILLIUM PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAMESWARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-523-5463
Mailing Address - Street 1:1431 CLAIBORNE CT
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7055
Mailing Address - Country:US
Mailing Address - Phone:937-523-5463
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2687
Practice Address - Country:US
Practice Address - Phone:937-523-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2553160Medicaid
608935900OtherFEDERAL BLACK LUNG PROG
608935900OtherFEDERAL BLACK LUNG PROG
OH2553160Medicaid
608935900OtherFEDERAL BLACK LUNG PROG