Basic Information
| Provider Information | |||||||||
| NPI: | 1093057655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCURATE PATHOLOGY SERVICES MD PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742515 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417664120 | ||||||||
| FaxNumber: | 9417664123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 HARBOR BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339525000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417664120 | ||||||||
| FaxNumber: | 9417664123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOMBA | ||||||||
| AuthorizedOfficialFirstName: | FERNANDO | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9417664120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.