MEDICARE: NORTHWEST 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1447941174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PATHOLOGY PLLC

Provider Business Mailing Address
First Line	:	3560 MERIDIAN ST STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1731
Country	:	US
Telephone Number	:	360-734-2800
Fax Number	:	360-734-0426

Provider Business Practice Location Address
First Line	:	111 S 12TH ST STE D
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4000
Country	:	US
Telephone Number	:	877-232-9924
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GREGORY WOLGAMOT
Credential	:	MD
Telephone Number	:	360-734-2800

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	12/15/2025

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