Organization
MATTISON PATHOLOGY, L.L.P.
Active
Other names
Avero Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY M WOLGAMOT M.D., PH.D. (MEDICAL DIRECTOR)
(866) 987-7284
Entity
Organization
Contact information
Practice address
4245 N CENTRAL EXPY STE 420, DALLAS, TX 75205-4566
(866) 987-7284
(469) 232-9927
Mailing address
3560 MERIDIAN ST STE 101, BELLINGHAM, WA 98225-1731
(360) 734-2800
(360) 734-0426
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z224
MEDICARE PTAN
—
01
—
45D1015603
CLIA
TX
01
—
45D1065927
CLIA
TX
01
—
45D1069527
CLIA #
TX
01
—
7187034
COLLEGE OF AMERICAN PATHOLOGISTS
TX
01
—
7201511
COLLEGE OF AMERICAN PATHOLOGISTS
TX
Enumeration date
07/02/2007
Last updated
12/15/2025
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