Basic Information
| Provider Information | |||||||||
| NPI: | 1417391749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSOLIDATED DERMPATH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 SW 30TH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330694887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668367136 | ||||||||
| FaxNumber: | 9546333397 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 SW 30TH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330694887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003306770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICAL | ||||||||
| AuthorizedOfficialTelephone: | 8002570117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 800001294 | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.