Basic Information
| Provider Information | |||||||||
| NPI: | 1750365474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINLAND PATHOLOGY ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 420998 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772420998 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6807 EMMETT F LOWRY EXPY | ||||||||
| Address2: | |||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134813545 | ||||||||
| FaxNumber: | 7134320221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | AHMEDUDDIN | ||||||||
| AuthorizedOfficialFirstName: | JAMEELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED REP. | ||||||||
| AuthorizedOfficialTelephone: | 7134813545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | CI2354 | 01 | TX | RAILROAD MEDICARE | OTHER |