Provider Demographics
NPI:1487770129
Name:UNIVERSITY PATHOLOGY
Entity type:Organization
Organization Name:UNIVERSITY PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-2662
Mailing Address - Street 1:825 CHALKSTONE AVE
Mailing Address - Street 2:ROGER WILLIAMS MED CTR, PATHOLOGY DEPT.
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4728
Mailing Address - Country:US
Mailing Address - Phone:401-456-2171
Mailing Address - Fax:401-456-2663
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:ROGER WILLIAMS MED CTR, PATHOLOGY DEPT.
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-2171
Practice Address - Fax:401-456-2663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1487770Medicaid
RI1487770Medicaid