Provider Demographics
NPI:1154651230
Name:SEACOAST PATHOLOGY INC
Entity Type:Organization
Organization Name:SEACOAST PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRATTENDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-626-5512
Mailing Address - Street 1:11025 RCA CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4269
Mailing Address - Country:US
Mailing Address - Phone:561-626-5512
Mailing Address - Fax:561-626-4530
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4848
Practice Address - Country:US
Practice Address - Phone:866-484-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03236291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty