Provider Demographics
NPI:1962054312
Name:PATHOLOGY ASSOCIATES OF FAIRFIELD COUNTY, LLC.
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF FAIRFIELD COUNTY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FML LAB MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-687-8292
Mailing Address - Street 1:3769 COLUMBUS PIKE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:614-717-9840
Mailing Address - Fax:614-652-9159
Practice Address - Street 1:401 N. EWING STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty