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PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION

Physicians Pathology Immunopathology

Provider NPI: 1093843450

Organization Information:
Organization Name:  PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION
Organization is not Subpart
Authorized Official:  JANNA M DIETEL  CREDENTIALING SPECIALIST  225-706-0513

Practice Location:
5339 O'DONOVAN DRIVE  BATON ROUGE, LA 70808 US
Tel: 225-766-4999  Fax: 225-763-5870

Business Mailing Address:
PO BOX 84030  BATON ROUGE, LA 70884-4030 US
Tel: 225-766-4999  Fax: 225-763-5870

NPI Information:
NPI: 1093843450
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N207ZI0100XPhysicians
Pathology
Immunopathology
N207ZM0300XPhysicians
Pathology
N207ZN0500XPhysicians
Pathology
N207ZP0007XPhysicians
Pathology
N207ZP0213XPhysicians
Pathology
N207ZB0001XPhysicians
Pathology
N207ZH0000XPhysicians
Pathology
N207ZC0500XPhysicians
Pathology
N207ZD0900XPhysicians
Pathology
Y207ZP0102XPhysicians
Pathology

Other Provider Identifiers:

IssuerNumberStateType
1184781LA05



American Medical Association 2012 taxonomy code information

Code: 207ZP0102X

Type:

Classification:



Definition:



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