Provider Demographics
NPI:1053310615
Name:ATLANTIC PATHOLOGISTS PC
Entity Type:Organization
Organization Name:ATLANTIC PATHOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-441-2147
Mailing Address - Street 1:PO BOX 95000-2705
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2705
Mailing Address - Country:US
Mailing Address - Phone:609-441-2147
Mailing Address - Fax:609-441-2107
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-441-2147
Practice Address - Fax:609-441-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-17
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D0005562207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3459705Medicaid
NJ3459705Medicaid
NJ=========OtherBLUE CROSS BLUE SHIELD
NJ663823Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER