Healthcare Provider Details

I. General information

NPI: 1245591965
Provider Name (Legal Business Name): NORTH SHORE PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

IV. Provider business mailing address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax: 440-808-2060
Mailing address:
  • Phone: 440-808-1212
  • Fax: 440-808-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS WAYNAR
Title or Position: COO
Credential:
Phone: 440-250-7698