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General NPI Number Information
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NPI Number | 1982002473
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Entity Type | Organization
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Legal Business Name | BREVARD PATHOLOGY SERVICES PA
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 1350 HICKORY ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3224
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Country | US
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Telephone | 321-953-4804
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Fax | 321-728-7176
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Provider Business Mailing Address
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Address Line | 2080 S RIVER RD
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City | MELBOURNE BEACH
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State | FL
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Zip | 32951-2928
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Country | US
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Telephone | 321-953-4804
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Fax | 321-728-7176
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. CHARLES CHODOROW
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Credential | MD
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Telephone | 321-953-4804
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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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