MEDICARE: SUN PATHOLOGY, PA

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1740224591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN PATHOLOGY, PA

Provider Business Mailing Address
First Line	:	5901 SW 74TH ST
Second Line	:	SUITE 202
City	:	MIAMI
State	:	FL
Zip	:	33143-5165
Country	:	US
Telephone Number	:	305-665-4614
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 INDIAN ROCKS RD S
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-1035
Country	:	US
Telephone Number	:	305-665-4614
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARTIN LEWIS
Credential	:	M.D.
Telephone Number	:	305-665-4614

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/22/2020

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