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General NPI Number Information
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NPI Number | 1578219648
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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 | 02/26/2022
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 2500 SW 75TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-2805
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Country | US
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Telephone | 305-264-5252
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Fax | 305-455-2811
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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 | 305-835-6107
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Fax | 305-694-3622
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Authorized Official
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Title or Position | OWNER / AUTHORIZED OFFICIAL
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Name | SUSAN BAKER
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Credential | MD
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Telephone | 305-835-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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