Healthcare Provider Details

I. General information

NPI: 1962485581
Provider Name (Legal Business Name): SEACOAST PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DR
EXETER NH
03833-2128
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 603-778-8522
  • Fax:
Mailing address:
  • Phone: 561-626-5512
  • Fax: 561-626-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C. GRATTENDICK
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-626-5512