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NPI Code Detail

MEDICARE: GI PATHOLOGY, LLC

MEDICARE: GI PATHOLOGY, LLC
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
1207ZP0105XClinical Pathology/Laboratory Medicine Physician3558015OH

General Provider Information

NPI Number : 1588955470
Entity Type Code : Organization
Provider Name (Legal Business Name) : GI PATHOLOGY, LLC
Provider Business Mailing Address
First Line : PO BOX 714009
Second Line :
City : COLUMBUS
State : OH
Zip : 43271-4009
Country : US
Telephone Number : 330-399-7215
Fax Number : 330-399-2411
Provider Business Practice Location Address
First Line : 1622 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44483-6613
Country : US
Telephone Number : 330-399-7215
Fax Number : 330-399-2411
Authorized Official
Title or Position : PRESIDENT
Name : DR. ADEL YOUSSEF
Credential : M.D.
Telephone Number : 330-399-7215
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/26/2011

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