MEDICARE: USA PATH LAB, 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		FL

General Provider Information

NPI Number	:	1528125705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA PATH LAB, LLC

Provider Business Mailing Address
First Line	:	4224 N TAMPANIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6322
Country	:	US
Telephone Number	:	813-876-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 N TAMPANIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6322
Country	:	US
Telephone Number	:	813-876-2500
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	NARIOSANG M KANDAWALLA
Credential	:	M.D.
Telephone Number	:	813-876-2500

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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