Basic Information
| Provider Information | |||||||||
| NPI: | 1043347297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S WILSON DIAGNOSTIC PATHOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49 | ||||||||
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| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152300049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003437123 | ||||||||
| FaxNumber: | 4129375710 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243577169 | ||||||||
| FaxNumber: | 7243577481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7243577169 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MD025714E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.