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General NPI Number Information
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NPI Number | 1902887995
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA PATHOLOGY LABORATORY, LLC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 3330 MASONIC DR LABORATORY
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3841
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Country | US
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Telephone | 318-443-0941
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Fax | 318-443-5734
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Provider Business Mailing Address
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Address Line | PO BOX 12116 3510 PARLIAMENT CT.
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City | ALEXANDRIA
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State | LA
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Zip | 71315-2116
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Country | US
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Telephone | 318-443-0941
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Fax | 318-443-5734
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. SUDHA G PILLARISETTI
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Credential | M.D.
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Telephone | 318-443-0941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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