Provider Demographics
NPI:1801983226
Name:ST. TAMMANY PATHOLOGY
Entity type:Organization
Organization Name:ST. TAMMANY PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-293-1075
Mailing Address - Street 1:1202 S TYLER ST # 8T
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2330
Mailing Address - Country:US
Mailing Address - Phone:225-293-1075
Mailing Address - Fax:225-293-1807
Practice Address - Street 1:2644 S SHERWOOD FRST STE 121
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2248
Practice Address - Country:US
Practice Address - Phone:225-292-6354
Practice Address - Fax:225-293-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D439Medicare ID - Type UnspecifiedCLINIC MEDICARE