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NPI Code Detail

MEDICARE: TROY PATHOLOGY PLLC

MEDICARE: TROY PATHOLOGY PLLC
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number : 1235114091
Entity Type Code : Organization
Provider Name (Legal Business Name) : TROY PATHOLOGY PLLC
Provider Business Mailing Address
First Line : PO BOX 1264
Second Line :
City : LATHAM
State : NY
Zip : 12110-8764
Country : US
Telephone Number : 518-786-1296
Fax Number : 518-786-1293
Provider Business Practice Location Address
First Line : 1300 MASSACHUSETTS AVE
Second Line :
City : TROY
State : NY
Zip : 12180-1628
Country : US
Telephone Number : 518-268-5435
Fax Number :
Authorized Official
Title or Position : CREDENTIALING CLERK
Name : VISHNU MEHROTRA
Credential : MD
Telephone Number : 518-268-5422
Provider Enumeration Date : 12/14/2005
Last Update Date : 08/22/2020

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