MEDICARE: PALMETTO PATHOLOGY SERVICES PA

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	ME 14215	FL

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	:	1326331604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PATHOLOGY SERVICES PA

Provider Business Mailing Address
First Line	:	PO BOX 3093
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-0993
Country	:	US
Telephone Number	:	305-822-6914
Fax Number	:	305-822-2676

Provider Business Practice Location Address
First Line	:	8665 BIRD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3215
Country	:	US
Telephone Number	:	305-441-6845
Fax Number	:	305-461-6911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FREDERICK CHARLES LANCET
Credential	:	MD
Telephone Number	:	305-822-6914

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/10/2022

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