Provider Demographics
NPI:1427170125
Name:WASHINGTON COUNTY PATHOLOGISTS PC
Entity type:Organization
Organization Name:WASHINGTON COUNTY PATHOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WCP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:DIANNE STOVALL
Authorized Official - Last Name:URSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-681-1147
Mailing Address - Street 1:335 SE 8TH AVENUE
Mailing Address - Street 2:WASHINGTON COUNTY PATHOLOGISTS PC
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4248
Mailing Address - Country:US
Mailing Address - Phone:503-681-1147
Mailing Address - Fax:503-681-1903
Practice Address - Street 1:335 SE 8TH AVENUE
Practice Address - Street 2:WASHINGTON COUNTY PATHOLOGISTS PC
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4248
Practice Address - Country:US
Practice Address - Phone:503-681-1147
Practice Address - Fax:503-681-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR053756Medicaid
ORR0000WCPFVMedicare PIN