Healthcare Provider Details

I. General information

NPI: 1154462307
Provider Name (Legal Business Name): CLARION PATHOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214
US

IV. Provider business mailing address

PO BOX 310
SENECA PA
16346-0310
US

V. Phone/Fax

Practice location:
  • Phone: 814-354-7397
  • Fax:
Mailing address:
  • Phone: 814-354-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001058927
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JAMES L. PUCKETT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 814-226-1399