Provider Demographics
NPI:1306874912
Name:WEIRTON PATHOLOGY ASSOCIATES
Entity type:Organization
Organization Name:WEIRTON PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANCAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-797-6332
Mailing Address - Street 1:PO BOX 2288
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1488
Mailing Address - Country:US
Mailing Address - Phone:304-797-6332
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:LAB
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20178207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4005067000Medicaid
OH2316701Medicaid
WV9322111Medicare ID - Type Unspecified
OH2316701Medicaid
G47072Medicare UPIN