Organization
HAZLETON PATHOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY A. NULL MD (PRESIDENT)
(570) 454-6301
Entity
Organization
Contact information
Practice address
148 N SHERMAN COURT, HAZLETON, PA 18201-5863
(570) 454-6301
(570) 454-6815
Mailing address
PO BOX 1388, KINGSTON, PA 18704
(570) 288-8881
(570) 288-8065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012214720008
—
PA
01
—
635079
BLUE SHIELD
PA
Enumeration date
07/25/2006
Last updated
08/06/2015
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