Organization
ALLIED PATHOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALDINE PETERDY MD (PRESIDENT)
(509) 255-1000
Entity
Organization
Contact information
Practice address
112 S GREENRIDGE DR, LIBERTY LAKE, WA 99019-9566
(509) 255-1000
Mailing address
PO BOX 727, LIBERTY LAKE, WA 99019-0727
(509) 255-1000
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
603411100
WA
207ZP0101X
Anatomic Pathology Physician
Primary
603411100
WA
291U00000X
Clinical Medical Laboratory
603411100
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992119127
—
ID
01
—
G8930333
MEDICARE ID
—
Enumeration date
06/16/2014
Last updated
06/28/2016
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