MEDICARE: PALO ALTO PATHOLOGY, INC

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	291U00000X	Clinical Medical Laboratory	206746	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568509727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO ALTO PATHOLOGY, INC

Provider Business Mailing Address
First Line	:	2325 EL CAMINO REAL
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-1620
Country	:	US
Telephone Number	:	650-617-1849
Fax Number	:	650-327-2234

Provider Business Practice Location Address
First Line	:	2325 EL CAMINO REAL
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94306-1620
Country	:	US
Telephone Number	:	650-617-1849
Fax Number	:	650-327-2234

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	DR. KENNETH HADLER
Credential	:	MD
Telephone Number	:	650-617-1849

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	10/16/2007

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