Healthcare Provider Details

I. General information

NPI: 1558451666
Provider Name (Legal Business Name): DERMPATH NEW ENGLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 SOLDIERS FIELD RD STE 3800
BOSTON MA
02135-1047
US

IV. Provider business mailing address

11025 RCA CENTER DR STE 300
PALM BEACH GARDENS FL
33410-4269
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-7284
  • Fax: 617-254-4116
Mailing address:
  • Phone: 615-145-8225
  • Fax: 844-751-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number3429
License Number StateMA

VIII. Authorized Official

Name: MICHAEL C. GRATTENDICK
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-514-5822