Healthcare Provider Details

I. General information

NPI: 1588955470
Provider Name (Legal Business Name): GI PATHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E MARKET ST
WARREN OH
44483-6613
US

IV. Provider business mailing address

PO BOX 714009
COLUMBUS OH
43271-4009
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-7215
  • Fax: 330-399-2411
Mailing address:
  • Phone: 330-399-7215
  • Fax: 330-399-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number3558015
License Number StateOH

VIII. Authorized Official

Name: DR. ADEL YOUSSEF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-399-7215