MEDICARE: LOS GATOS PATHOLOGY GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1184618712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS GATOS PATHOLOGY GROUP

Provider Business Mailing Address
First Line	:	815 POLLARD RD
Second Line	:	DEPT OF PATHOLOGY
City	:	LOS GATOS
State	:	CA
Zip	:	95032-1438
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	S ROBERT FREEDMAN
Credential	:	M.D.
Telephone Number	:	408-866-4060

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/28/2014

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