Healthcare Provider Details

I. General information

NPI: 1538131362
Provider Name (Legal Business Name): INSTITUTE FOR DERMATOPATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W CHESTER PIKE BLDG D, STE. 120
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 610-260-0555
  • Fax: 610-260-0566
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number39D0698461
License Number StatePA

VIII. Authorized Official

Name: KRISTIE M DOLAN
Title or Position: DIRECTOR
Credential:
Phone: 866-697-8378