Basic Information
| Provider Information | |||||||||
| NPI: | 1578744223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTTSTOWN PATHOLOGY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MERIDIAN BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103724957 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E HIGH ST | ||||||||
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| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194645008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102377238 | ||||||||
| FaxNumber: | 6709703118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2007 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | DIMARZIO | ||||||||
| AuthorizedOfficialFirstName: | DANTE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6103277238 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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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.