Board Certified Dermatopathology, Inc
Organization Active NPI Dermatopathology (Pathology) Physician · Youngstown, OH
NPI 1902963358 · NPPES record last updated Mar 10, 2023
Key facts
- NPI
- 1902963358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatopathology (Pathology) Physician 207ZD0900X
- License
- 35074029 (OH)
- Legal business name
- BOARD CERTIFIED DERMATOPATHOLOGY, INC
- Practice address
- 5208 Mahoning Ave
Suite 208
Youngstown, OH 44515-1858 - Phone
- (330) 799-9270
- Fax
- (330) 799-2295
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Pamela Marie Guerriere-Kovach, M.D.
- Title
- Doctor
- Phone
- (330) 270-1832
National Provider Directory
Locations
5208 Mahoning Ave
Ste 208
Youngstown, OH 44515
Phone (330) 779-3389
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician |
207ZD0900X | 35074029 | OH | Yes |
| Dermatopathology (Pathology) Physician |
207ZD0900X | ME84498 | FL | |
| Dermatopathology (Pathology) Physician |
207ZD0900X | MD418830 | PA | |
| Dermatopathology (Pathology) Physician |
207ZD0900X | 0101231016 | VA | |
| Dermatopathology (Pathology) Physician |
207ZD0900X | 20881 | WV |
Addresses
Primary practice location
5208 Mahoning Ave
Suite 208
Youngstown, OH 44515-1858
Mailing address
5208 Mahoning Ave
Suite 208
Youngstown, OH 44515-1858
Phone (330) 799-9270
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000282926 | Other | OH | ANTHEM BCBS PROVIDER # |
| 2407818 | Medicaid | OH | |
| 6703070000 | Medicaid | WV | |
| 010128099 | Medicaid | VA |
Other names
- BCD, Inc
Other providers in Youngstown, OH
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- Dallan James Blotter
- Linda L Blum
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- Boardman Gastroenterology Group, Inc.
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All providers in Youngstown, OH · Dermatopathology (Pathology) Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.