Healthcare Provider Details

I. General information

NPI: 1417391749
Provider Name (Legal Business Name): CONSOLIDATED DERMPATH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENTREE RD
PITTSBURGH PA
15220-3508
US

IV. Provider business mailing address

500 PLAZA DR
SECAUCUS NJ
07094-3619
US

V. Phone/Fax

Practice location:
  • Phone: 800-845-3573
  • Fax:
Mailing address:
  • Phone: 866-836-7136
  • Fax: 954-633-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800001294
License Number StateFL

VIII. Authorized Official

Name: DARREN THOMAS WHEELER
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 973-520-2700