Healthcare Provider Details

I. General information

NPI: 1902887995
Provider Name (Legal Business Name): ALEXANDRIA PATHOLOGY LABORATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MASONIC DR LABORATORY
ALEXANDRIA LA
71301-3841
US

IV. Provider business mailing address

PO BOX 12116 3510 PARLIAMENT CT.
ALEXANDRIA LA
71315-2116
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-0941
  • Fax: 318-443-5734
Mailing address:
  • Phone: 318-443-0941
  • Fax: 318-443-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. SUDHA G PILLARISETTI
Title or Position: OWNER/PARTNER
Credential: M.D.
Phone: 318-443-0941