MEDICARE: ATLANTIC DERMATOPATHOLOGY, 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	291U00000X	Clinical Medical Laboratory	030360	PA

General Provider Information

NPI Number	:	1124211875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC DERMATOPATHOLOGY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 523
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-0523
Country	:	US
Telephone Number	:	215-673-0423
Fax Number	:	866-865-1697

Provider Business Practice Location Address
First Line	:	10 INDUSTRIAL HIGHWAY
Second Line	:	AIRPORT BUSINESS COMPLEX - Q3, SUITE 1
City	:	LESTER
State	:	PA
Zip	:	19029-1001
Country	:	US
Telephone Number	:	610-521-5040
Fax Number	:	610-521-5044

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. AMELIA M ZIMMARO
Credential	:
Telephone Number	:	610-521-5040

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	02/17/2014

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