Provider Demographics
NPI:1306902283
Name:GREATER VALLEY PATHOLOGY GROUP PA
Entity type:Organization
Organization Name:GREATER VALLEY PATHOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MATTIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-2225
Mailing Address - Street 1:600 WICHITA AVE
Mailing Address - Street 2:APT #501
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-3047
Mailing Address - Country:US
Mailing Address - Phone:956-630-2225
Mailing Address - Fax:956-630-2275
Practice Address - Street 1:600 WICHITA AVE
Practice Address - Street 2:APT #501
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-3047
Practice Address - Country:US
Practice Address - Phone:956-630-2225
Practice Address - Fax:956-630-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID