Healthcare Provider Details

I. General information

NPI: 1235191305
Provider Name (Legal Business Name): UCSF DERMATOPATHOLOGY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST SUITE 280
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

1701 DIVISADERO ST, STE 280
SAN FRANCISCO CA
94115-3011
US

V. Phone/Fax

Practice location:
  • Phone: 800-497-0244
  • Fax: 415-353-7553
Mailing address:
  • Phone: 800-497-0244
  • Fax: 415-353-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY H MCCALMONT
Title or Position: LABORATORY DIRECTOR
Credential: MD
Phone: 415-353-7550