Provider Demographics
NPI:1174508600
Name:MAINLAND PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:MAINLAND PATHOLOGY ASSOCIATES PA
Other - Org Name:CYTOLOGY ASSOCIATES OF HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REP
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMEDUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-481-3545
Mailing Address - Street 1:PO BOX 420998
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-0998
Mailing Address - Country:US
Mailing Address - Phone:713-481-3545
Mailing Address - Fax:
Practice Address - Street 1:11949 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1425
Practice Address - Country:US
Practice Address - Phone:281-988-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX690009264OtherRAILROAD MEDICARE
TX690009264OtherRAILROAD MEDICARE