Provider Demographics
NPI:1770521528
Name:CENTRAL OHIO PATHOLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:CENTRAL OHIO PATHOLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HASTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-898-4454
Mailing Address - Street 1:PO BOX 951427
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0016
Mailing Address - Country:US
Mailing Address - Phone:614-442-2400
Mailing Address - Fax:614-442-2403
Practice Address - Street 1:275 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1445
Practice Address - Country:US
Practice Address - Phone:614-442-2400
Practice Address - Fax:614-442-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCE9299712Medicare ID - Type Unspecified