1821060641 NPI number — INSTITUTE FOR DERMATOPATHOLOGY, INC.

Table of content: (NPI 1821060641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821060641 NPI number — INSTITUTE FOR DERMATOPATHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR DERMATOPATHOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERIPATH PITTSBURGH, PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821060641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 GREENTREE ROAD, SUITE 325
Provider Second Line Business Practice Location Address:
FOUR PARKWAY CENTER
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-845-3573
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
VICE PRESIDENT/AUTHORIZE OFFICIAL
Authorized Official Telephone Number:
610-550-3003

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  39D0177150 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6701101000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01016391 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007508900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2335262 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007508900004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308055 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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