Organization
JEANNETTE DIAGNOSTIC PATHOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRIMO V BAUTISIA MD (PRESIDENT)
(724) 527-6517
Entity
Organization
Contact information
Practice address
600 JEFFERSON AVE, JEANNETTE, PA 15644-0600
(724) 527-3551
(724) 527-6519
Mailing address
PO BOX 157, GRAPEVILLE, PA 15634
(724) 527-6517
(724) 527-6519
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019160310002
—
PA
Enumeration date
05/17/2006
Last updated
08/22/2020
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