# PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093843450
- **Authorized official:** JANNA M DIETEL (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (225) 706-0513

## Contact information

- **Practice address:** 5339 O'DONOVAN DRIVE, BATON ROUGE, LA 70808
- **Practice address phone:** (225) 766-4999
- **Practice address fax:** (225) 763-5870
- **Mailing address:** PO BOX 84030, BATON ROUGE, LA 70884-4030
- **Mailing address phone:** (225) 766-4999
- **Mailing address fax:** (225) 763-5870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZB0001X | Blood Banking & Transfusion Medicine Physician | — | NULL | — |
| 207ZB0001X | Blood Banking & Transfusion Medicine Physician | — | — | — |
| 207ZC0500X | Cytopathology Physician | — | NULL | — |
| 207ZC0500X | Cytopathology Physician | — | — | — |
| 207ZD0900X | Dermatopathology (Pathology) Physician | — | NULL | — |
| 207ZD0900X | Dermatopathology (Pathology) Physician | — | — | — |
| 207ZH0000X | Hematology (Pathology) Physician | — | NULL | — |
| 207ZH0000X | Hematology (Pathology) Physician | — | — | — |
| 207ZI0100X | Immunopathology Physician | — | NULL | — |
| 207ZI0100X | Immunopathology Physician | — | — | — |
| 207ZM0300X | Medical Microbiology Physician | — | NULL | — |
| 207ZM0300X | Medical Microbiology Physician | — | — | — |
| 207ZN0500X | Neuropathology Physician | — | NULL | — |
| 207ZN0500X | Neuropathology Physician | — | — | — |
| 207ZP0007X | Molecular Genetic Pathology (Pathology) Physician | — | NULL | — |
| 207ZP0007X | Molecular Genetic Pathology (Pathology) Physician | — | — | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |
| 207ZP0213X | Pediatric Pathology Physician | — | NULL | — |
| 207ZP0213X | Pediatric Pathology Physician | — | — | — |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 04/27/2020