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General NPI Number Information
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NPI Number | 1134193634
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Entity Type | Organization
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Legal Business Name | EAST COAST PATHOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 1100 NW 95TH ST
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City | MIAMI
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State | FL
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Zip | 33150-2038
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Country | US
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Telephone | 305-835-4725
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5040
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City | HIALEAH
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State | FL
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Zip | 33014-1040
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Country | US
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Telephone | 305-503-6320
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Fax | 305-503-6329
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN BAKER
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Credential | M.D.
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Telephone | 305-835-4725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | ME46836
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | ME46836
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME46836
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License Number State | FL
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