MEDICARE: WASHINGTON COUNTY PATHOLOGISTS PC

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427170125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON COUNTY PATHOLOGISTS PC

Provider Business Mailing Address
First Line	:	335 SE 8TH AVENUE
Second Line	:	WASHINGTON COUNTY PATHOLOGISTS PC
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4248
Country	:	US
Telephone Number	:	503-681-1147
Fax Number	:	503-681-1903

Provider Business Practice Location Address
First Line	:	335 SE 8TH AVENUE
Second Line	:	WASHINGTON COUNTY PATHOLOGISTS PC
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4248
Country	:	US
Telephone Number	:	503-681-1147
Fax Number	:	503-681-1903

Authorized Official
Title or Position	:	WCP PRESIDENT
Name	:	DR. DONNA DIANNE STOVALL URSTADT
Credential	:	MD
Telephone Number	:	503-681-1147

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	04/30/2008

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