Healthcare Provider Details

I. General information

NPI: 1760689871
Provider Name (Legal Business Name): PALM BEACH PATHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 PONCE DE LEON AVE
WEST PALM BEACH FL
33407-6019
US

IV. Provider business mailing address

PO BOX 4117
WEST PALM BEACH FL
33402-4117
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-0770
  • Fax: 770-776-5966
Mailing address:
  • Phone: 561-659-0770
  • Fax: 770-776-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A BOLTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 561-659-0770