Provider Demographics
NPI:1285713826
Name:LABORATORY & PATHOLOGY DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:LABORATORY & PATHOLOGY DIAGNOSTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-730-3843
Mailing Address - Street 1:DEPARTMENT 4387
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4387
Mailing Address - Country:US
Mailing Address - Phone:630-355-0450
Mailing Address - Fax:630-527-3911
Practice Address - Street 1:801 S WASHINGTON STREET
Practice Address - Street 2:EDWARD HOSPITAL
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60566-7060
Practice Address - Country:US
Practice Address - Phone:630-355-0450
Practice Address - Fax:630-527-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL394350Medicare ID - Type Unspecified