Provider Demographics
NPI:1699097360
Name:ALEXANDRIA PATHOLOGY LABORATORY, LLC
Entity type:Organization
Organization Name:ALEXANDRIA PATHOLOGY LABORATORY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PILLARISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-0941
Mailing Address - Street 1:PO BOX 12116
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2116
Mailing Address - Country:US
Mailing Address - Phone:318-443-0941
Mailing Address - Fax:
Practice Address - Street 1:3510 PARLIAMENT CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3135
Practice Address - Country:US
Practice Address - Phone:318-443-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441996Medicaid