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NPI Code Detail

MEDICARE: SKIN PATHOLOGY SERVICES INC

MEDICARE: SKIN PATHOLOGY SERVICES 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
1291U00000XClinical Medical Laboratory36D0656150OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629063938
Entity Type Code : Organization
Provider Name (Legal Business Name) : SKIN PATHOLOGY SERVICES INC
Provider Business Mailing Address
First Line : 2660 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44483-6204
Country : US
Telephone Number : 330-393-4003
Fax Number : 330-393-0074
Provider Business Practice Location Address
First Line : 2660 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44483-6204
Country : US
Telephone Number : 330-393-4003
Fax Number : 330-393-0074
Authorized Official
Title or Position : LABORATORY DIRECTOR/PRESIDENT
Name : DR. ROBERT T BRODELL
Credential : MD
Telephone Number : 330-393-4003
Provider Enumeration Date : 09/13/2005
Last Update Date : 03/01/2012

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