Provider Demographics
NPI:1215942933
Name:STRATA PATHOLOGY SERVICES INC
Entity type:Organization
Organization Name:STRATA PATHOLOGY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-245-2256
Mailing Address - Street 1:PO BOX 532281
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-579-9387
Practice Address - Street 1:1 CRANBERRY HL STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7397
Practice Address - Country:US
Practice Address - Phone:800-325-7284
Practice Address - Fax:205-579-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110025649AMedicaid
M19224OtherBCBS MA
MAM21750Medicare ID - Type Unspecified