Healthcare Provider Details

I. General information

NPI: 1962464792
Provider Name (Legal Business Name): HANOVER PATHOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHLAND AVE
HANOVER PA
17331-2297
US

IV. Provider business mailing address

900 BRYAN ST PO BOX 382, SUITE 2
HUNTINGDON PA
16652-2413
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-6207
  • Fax: 814-643-6165
Mailing address:
  • Phone: 814-643-6207
  • Fax: 814-643-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number39D0187385
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number39D0187385
License Number StatePA

VIII. Authorized Official

Name: DR. JESUS SOCRATES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 814-643-6207