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Contact Information

BOARD CERTIFIED DERMATOPATHOLOGY, INC
5208 MAHONING AVE
SUITE 208
YOUNGSTOWN, OH44515-1858
 Phone: 330-799-9270
 Fax: 330-799-2295
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatopathology

207ZD0900X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for BOARD CERTIFIED DERMATOPATHOLOGY, INC

NPI # 1902963358
LBN Legal business name BOARD CERTIFIED DERMATOPATHOLOGY, INC
Authorized official PAMELA GUERRIERE-KOVACH - (DOCTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 01/03/2007
Last updated 03/10/2023 - About 3 years ago
Identifiers
FL License # ME84498
OH License # 35074029
PA License # MD418830
VA License # 0101231016
WV License # 20881
OH Medicaid 2407818
VA Medicaid 010128099
WV Medicaid 6703070000
OH Other 000000282926 ANTHEM BCBS PROVIDER #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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