Organization
GATEWAY PATHOLOGY ASSOC
Active
Organization
GATEWAY PATHOLOGY ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELPIDIO G MARIANO MD (MANAGING PARTNER)
(563) 242-5316
Entity
Organization
Contact information
Practice address
1410 N 4TH STREET, CLINTON, IA 52732
(563) 242-5316
(563) 242-3128
Mailing address
PO BOX 0361, CLINTON, IA 52733-0361
(563) 242-5316
(563) 242-3128
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
21940
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0477950
—
IA
01
—
31964
BC BS
IA
01
—
DC6462
RR MEDICARE
—
Enumeration date
01/26/2007
Last updated
11/06/2007
Update your record
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