Healthcare Provider Details

I. General information

NPI: 1255582383
Provider Name (Legal Business Name): DERMATOPATHOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 JOHNNIE DODDS BLVD UNIT 104
MT PLEASANT SC
29464-3285
US

IV. Provider business mailing address

570 LONG POINT RD SUITE 230
MT PLEASANT SC
29464
US

V. Phone/Fax

Practice location:
  • Phone: 843-284-4799
  • Fax: 843-284-4798
Mailing address:
  • Phone: 843-284-4799
  • Fax: 843-284-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number8871
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: CATHARINE MARIE HOLLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-284-4798