Healthcare Provider Details

I. General information

NPI: 1922273317
Provider Name (Legal Business Name): PALM BEACH PATHOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

IV. Provider business mailing address

PO BOX 4117
WEST PALM BEACH FL
33402-4117
US

V. Phone/Fax

Practice location:
  • Phone: 954-240-9555
  • Fax: 770-776-5966
Mailing address:
  • Phone: 954-240-9555
  • Fax: 770-776-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS A BOLTON
Title or Position: PRESIDENT
Credential: MD
Phone: 954-240-9555