Provider Demographics
NPI:1861422107
Name:LAUREL PATHOLOGY, PC
Entity type:Organization
Organization Name:LAUREL PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-444-8910
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-0336
Mailing Address - Country:US
Mailing Address - Phone:814-444-8910
Mailing Address - Fax:814-444-9782
Practice Address - Street 1:500 W BERKELEY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5514
Practice Address - Country:US
Practice Address - Phone:724-430-5159
Practice Address - Fax:724-430-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018644720003Medicaid
PA1520282Medicaid
PA2024671000OtherINDEPENDENCE BLUE CROSS
PA2024671000OtherPERSONAL CHOICE
PA1313083OtherBLUE SHIELD
PA051518Medicare PIN
PA0018644720003Medicaid