MEDICARE: MATTISON PATHOLOGY, L.L.P.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207ZC0500X	Cytopathology Physician
2	291U00000X	Clinical Medical Laboratory
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	00Z224	OTHER		MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D1065927	OTHER	TX	CLIA
2	7187034	OTHER	TX	COLLEGE OF AMERICAN PATHOLOGISTS
3	45D1015603	OTHER	TX	CLIA
4	7201511	OTHER	TX	COLLEGE OF AMERICAN PATHOLOGISTS
6	45D1069527	OTHER	TX	CLIA #
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1063619922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTISON PATHOLOGY, L.L.P.

Provider Business Mailing Address
First Line	:	3560 MERIDIAN ST STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1731
Country	:	US
Telephone Number	:	360-734-2800
Fax Number	:	360-734-0426

Provider Business Practice Location Address
First Line	:	4245 N CENTRAL EXPY STE 420
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-4566
Country	:	US
Telephone Number	:	866-987-7284
Fax Number	:	469-232-9927

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. GREGORY M WOLGAMOT
Credential	:	M.D., PH.D.
Telephone Number	:	866-987-7284

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	12/15/2025

4245 N CENTRAL EXPY STE 420
DALLAS, TX
75205-4566

Practice Phone: 972-707-9929
Practice Fax: