MEDICARE: PATHOLOGY NETWORK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1457195109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY NETWORK LLC

Provider Business Mailing Address
First Line	:	160 SW 12TH AVE STE 103C
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3119
Country	:	US
Telephone Number	:	561-507-0522
Fax Number	:	561-431-2922

Provider Business Practice Location Address
First Line	:	160 SW 12TH AVE STE 103C
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3119
Country	:	US
Telephone Number	:	561-507-0522
Fax Number	:	561-431-2922

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ANNA DZEVA
Credential	:
Telephone Number	:	561-507-0522

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	01/15/2026

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