Provider Demographics
NPI:1063870699
Name:INTERVENTIONAL PATHOLOGY OF OHIO LLC
Entity type:Organization
Organization Name:INTERVENTIONAL PATHOLOGY OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-825-0274
Mailing Address - Street 1:9834 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4151
Mailing Address - Country:US
Mailing Address - Phone:703-257-1440
Mailing Address - Fax:703-257-4337
Practice Address - Street 1:580 LINCOLN PARK BLVD
Practice Address - Street 2:344
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3474
Practice Address - Country:US
Practice Address - Phone:937-825-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089844207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2775804Medicaid