MEDICARE: INSTITUTE FOR DERMATOPATHOLOGY, INC.

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	39D0698461	PA

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
2	353193	OTHER	PA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538131362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR DERMATOPATHOLOGY, INC.

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	3805 W CHESTER PIKE
Second Line	:	BLDG D, STE. 120
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2304
Country	:	US
Telephone Number	:	610-260-0555
Fax Number	:	610-260-0566

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRISTIE M DOLAN
Credential	:
Telephone Number	:	866-697-8378

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	04/20/2023

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