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General NPI Number Information
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NPI Number | 1174983266
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Entity Type | Organization
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Legal Business Name | GIDWANI PATHOLOGY
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 3950 HOLLYWOOD BLVD SUITE 201-C
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City | HOLLYWOOD
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State | FL
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Zip | 33021
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Country | US
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Telephone | 844-443-9264
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Fax | 844-443-9264
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Provider Business Mailing Address
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Address Line | 3920 SW 186TH WAY
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City | MIRAMAR
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State | FL
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Zip | 33029-2720
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Country | US
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Telephone | 844-443-9264
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Fax | 844-443-9264
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | RAJA M GIDWANI
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Credential | M.D.
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Telephone | 844-443-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | ME109293
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License Number State | FL
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