MEDICARE: DERMATOPATHOLOGY CONSULTANTS, 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		NJ
2	207ND0900X	Dermatopathology Physician	MA68335	NJ

General Provider Information

NPI Number	:	1518155068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOPATHOLOGY CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	104 WHITE HORSE PIKE
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1908
Country	:	US
Telephone Number	:	856-310-1080
Fax Number	:	856-310-1081

Provider Business Practice Location Address
First Line	:	104 WHITE HORSE PIKE
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1908
Country	:	US
Telephone Number	:	856-310-1080
Fax Number	:	856-310-1081

Authorized Official
Title or Position	:	DERMATOPATHOLOGIST/PROPRIETOR
Name	:	DR. ROBERT ANDREW ALLEN
Credential	:	M.D.
Telephone Number	:	856-310-1080

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	06/02/2009

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