Provider Demographics
NPI:1548273733
Name:DERMATOPATHOLOGY ALLIANCE OF KENTUCKY PLLC
Entity type:Organization
Organization Name:DERMATOPATHOLOGY ALLIANCE OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:FEARNEYHOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-583-5834
Mailing Address - Street 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6217
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:839 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2209
Practice Address - Country:US
Practice Address - Phone:502-456-6217
Practice Address - Fax:502-456-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1223P0106X, 207N00000X
207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
151583XXOtherPREFERRED CARE
KY5115678OtherAETNA
KY78469OtherAETNA BETTER HEALTH
OH2676260Medicaid
WV6701094-000Medicaid
690009345OtherRAILROAD MEDICARE
MDBP87-0001OtherBC/BS MD
KY000000247638OtherANTHEM BLUE CROSS BS
VA277243OtherANTHEM BCBS MC SUPP
NH3103049Medicaid
KY7100173900Medicaid
VA000100269Medicaid
TN4409994Medicaid
KY50115665OtherPASSPORT
IN200364970AMedicaid
KY30004761050OtherCARESOURCE
KY611948801OtherUS DEPT LABOR BLACK LUNG
93434OtherHEALTH PARTNERS
KY01895510OtherANTHEM MA
KY611948800OtherUS DEPT LABOR DEEOIC
NH3103049Medicaid
KY78469OtherAETNA BETTER HEALTH
IN200364970AMedicaid