Provider Demographics
NPI:1982714861
Name:ANCHORAGE PATHOLOGY GROUP
Entity type:Organization
Organization Name:ANCHORAGE PATHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANANTWERP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-264-1171
Mailing Address - Street 1:PO BOX 140967
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0967
Mailing Address - Country:US
Mailing Address - Phone:907-561-1031
Mailing Address - Fax:907-561-1953
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:CLIINICAL LAB
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-264-1171
Practice Address - Fax:907-264-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225961207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK=========OtherANCHORAGE PATH GP TAX ID
AK=========OtherANCHORAGE PATH GP TAX ID
AKD36070Medicare UPIN