Healthcare Provider Details

I. General information

NPI: 1063474724
Provider Name (Legal Business Name): LATULIPPE PATHOLOGY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 5TH STREET
E LIVERPOOL OH
43920
US

IV. Provider business mailing address

PO BOX 5254
POLAND OH
44514-0254
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-7200
  • Fax:
Mailing address:
  • Phone: 330-520-2221
  • Fax: 330-776-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number35077781
License Number StateOH

VIII. Authorized Official

Name: STEVEN E LATULIPPE
Title or Position: OWNER
Credential: MD
Phone: 330-385-7200