Basic Information
| Provider Information | |||||||||
| NPI: | 1508212523 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BARABAN | ||||||||
| FirstName: | EZRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 SPRUCE STREET | ||||||||
| Address2: | HUP PATHOLOGY 6 FOUNDERS | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102997427 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 N WOLFE ST | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109555000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | TBD | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.