MEDICARE: UCSF DERMATOPATHOLOGY SERVICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry
2	291U00000X	Clinical Medical Laboratory
3	207ND0900X	Dermatopathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235191305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCSF DERMATOPATHOLOGY SERVICE

Provider Business Mailing Address
First Line	:	1701 DIVISADERO ST, STE 280
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3011
Country	:	US
Telephone Number	:	800-497-0244
Fax Number	:	415-353-7543

Provider Business Practice Location Address
First Line	:	1701 DIVISADERO ST
Second Line	:	SUITE 280
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3011
Country	:	US
Telephone Number	:	800-497-0244
Fax Number	:	415-353-7553

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	DR. TIMOTHY H MCCALMONT
Credential	:	MD
Telephone Number	:	415-353-7550

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	10/04/2018

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