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General NPI Number Information
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NPI Number | 1245401645
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Entity Type | Organization
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Legal Business Name | UNIVERSITY DERMATOPATHOLOGY CONSULTANTS PSC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 310 E BROADWAY SUITE 3A
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City | LOUISVILLE
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State | KY
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Zip | 40202-1745
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Country | US
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Telephone | 502-569-7711
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Fax | 502-587-8119
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Provider Business Mailing Address
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Address Line | 310 E BROADWAY SUITE 3A
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City | LOUISVILLE
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State | KY
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Zip | 40202-1745
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Country | US
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Telephone | 502-569-7711
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Fax | 502-587-8119
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JANINE C MALONE
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Credential | M.D.
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Telephone | 502-569-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | KY32113
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License Number State | KY
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