Basic Information
| Provider Information | |||||||||
| NPI: | 1962906917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPTUNE DIAGNOSTICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RICE MINE RD N. STE E | ||||||||
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| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354064079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450010 | ||||||||
| FaxNumber: | 2057521175 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 RICE MINE RD N STE E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354064079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450010 | ||||||||
| FaxNumber: | 2057521175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 03/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | ADISESHA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2053450010 | ||||||||
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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.