Williamsport Pathology Assocs.
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Williamsport, PA
NPI 1992818900 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1992818900
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- WILLIAMSPORT PATHOLOGY ASSOCS.
- Practice address
- 777 Rural Ave
Williamsport, PA 17701-3109 - Phone
- (570) 321-2321
- NPI assigned
- Aug 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Nicholas J Dillman, MD
- Title
- Treasurer
- Phone
- (800) 288-8325
Practitioners 8
-
Jamie L Adam, MD, PHD
-
David J Borys, MD
-
Jaclyn Rae Cappel, M.D.
-
Vandi Ly-Bryant, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050429000383 | PA | Part B Supplier - Clinic/Group Practice | 3678512555 |
Receives reassigned benefits from 7 practitioners Practice locations: Wellsboro, PA; Williamsport, PA; Muncy, PA; Jersey Shore, PA |
National Provider Directory
Locations
215 E Water St
Muncy, PA 17756
Phone (570) 327-8137
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | PA | Yes |
Addresses
Primary practice location
777 Rural Ave
Williamsport, PA 17701-3109
Mailing address
5700 Southwyck Blvd
Toledo, OH 43614-1509
Phone (800) 288-8325
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009692280005 | Medicaid | PA | |
| CC4291 | Other | PA | RR MEDICARE |
| 400563 | Other | PA | HIGHMARK/BLUE SHIELD |
| 0009692280003 | Medicaid | PA |
Other providers in Williamsport, PA
- Williamsport Home
- Williamsport North Operations LLC
- Williamsport North SNF Operations LLC
- Williamsport Obstetrics & Gynecology, P.C.
- Williamsport Orthopedic & Prosthetic Company Inc
- Williamsport Physical Medicine, Inc.
- Williamsport Physical Medicine, Inc.
- Williamsport Physical Medicine, Inc.
- Williamsport Physical Medicine, Inc.
- Williamsport Psychological Associates
All providers in Williamsport, PA · Anatomic Pathology & Clinical Pathology Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.