MEDICARE: NORTHSHORE PATHOLOGY SERVICES APMC

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

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	:	1437141132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSHORE PATHOLOGY SERVICES APMC

Provider Business Mailing Address
First Line	:	230 W HALL AVE
Second Line	:	PMB 400
City	:	SLIDELL
State	:	LA
Zip	:	70460-2635
Country	:	US
Telephone Number	:	985-785-2221
Fax Number	:	985-785-1118

Provider Business Practice Location Address
First Line	:	100 MEDICAL CENTER DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-5520
Country	:	US
Telephone Number	:	985-646-5060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECA CANDAL
Credential	:	MD
Telephone Number	:	985-646-5060

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/22/2020

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