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General NPI Number Information
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NPI Number | 1962485581
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Entity Type | Organization
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Legal Business Name | SEACOAST PATHOLOGY, INC.
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 5 ALUMNI DR
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City | EXETER
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State | NH
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Zip | 03833-2128
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Country | US
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Telephone | 603-778-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 11025 RCA CENTER DR SUITE 300
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4269
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Country | US
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Telephone | 561-626-5512
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Fax | 561-626-4530
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL C. GRATTENDICK
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Credential |
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Telephone | 561-626-5512
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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 |
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License Number State |
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Taxonomy #2
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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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