MEDICARE: MD PATH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF6343	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1023064573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD PATH LLC

Provider Business Mailing Address
First Line	:	PO BOX 144333
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-4333
Country	:	US
Telephone Number	:	407-422-9831
Fax Number	:	407-648-2065

Provider Business Practice Location Address
First Line	:	2201 45TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2047
Country	:	US
Telephone Number	:	561-842-6141
Fax Number	:	561-845-6272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIANA DOVAL
Credential	:	M.D.
Telephone Number	:	561-842-6141

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/07/2007

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Directions to “MD PATH LLC ” Practice Location

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