Healthcare Provider Details

I. General information

NPI: 1992798854
Provider Name (Legal Business Name): VALLEY PATHOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING STREET MIAMI VALLEY HOSPITAL PATHOLOGY DEPT
DAYTON OH
45409-2722
US

IV. Provider business mailing address

160 WYOMING STREET
DAYTON OH
45409-2740
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2978
  • Fax: 937-208-6137
Mailing address:
  • Phone: 937-224-9326
  • Fax: 937-224-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA R. BALAJ
Title or Position: PARTNER
Credential: MD
Phone: 937-224-9326