Healthcare Provider Details

I. General information

NPI: 1447941174
Provider Name (Legal Business Name): NORTHWEST PATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 12TH ST STE D
MOUNT VERNON WA
98274-4000
US

IV. Provider business mailing address

3560 MERIDIAN ST STE 101
BELLINGHAM WA
98225-1731
US

V. Phone/Fax

Practice location:
  • Phone: 877-232-9924
  • Fax:
Mailing address:
  • Phone: 360-734-2800
  • Fax: 360-734-0426

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: GREGORY WOLGAMOT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 360-734-2800