Provider Demographics
NPI:1164455010
Name:UNIV OF MD PATHOLOGY ASSOCIATES P A
Entity Type:Organization
Organization Name:UNIV OF MD PATHOLOGY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SURGICAL PATHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAPADIMITRIOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-328-5555
Mailing Address - Street 1:PO BOX 64592
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4592
Mailing Address - Country:US
Mailing Address - Phone:667-214-1610
Mailing Address - Fax:410-328-0929
Practice Address - Street 1:419 W REDWOOD ST STE 60
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1757
Practice Address - Country:US
Practice Address - Phone:667-214-1444
Practice Address - Fax:410-328-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD408291U00000X
MD418291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW020Medicare ID - Type Unspecified