Organization
DERMATOPATHOLOGY LABORATORY OF CENTRAL STATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS G. OLSEN M.D. (LABORATORY DIRECTOR)
(937) 434-2351
Entity
Organization
Contact information
Practice address
7835 PARAGON RD, DAYTON, OH 45459
(937) 434-2351
(937) 434-1381
Mailing address
7835 PARAGON RD, DAYTON, OH 45459-4021
(937) 434-2351
(937) 434-1381
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0222614
—
OH
Enumeration date
08/01/2006
Last updated
08/30/2018
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