MEDICARE: GREATER CINCINNATI PATHOLOGISTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1063658052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER CINCINNATI PATHOLOGISTS, INC.

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	1737 TENNESSEE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1201
Country	:	US
Telephone Number	:	513-585-1409
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMAD NAZEK
Credential	:	M.D.
Telephone Number	:	513-585-1409

Provider Enumeration Date	:	12/23/2008
Last Update Date	:	12/23/2008

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