Provider Demographics
NPI:1235191305
Name:UCSF DERMATOPATHOLOGY SERVICE
Entity Type:Organization
Organization Name:UCSF DERMATOPATHOLOGY SERVICE
Other - Org Name:UCSF DERMATOPATHOLOGY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCALMONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-353-7550
Mailing Address - Street 1:1701 DIVISADERO ST, STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3011
Mailing Address - Country:US
Mailing Address - Phone:800-497-0244
Mailing Address - Fax:415-353-7543
Practice Address - Street 1:1701 DIVISADERO ST
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3011
Practice Address - Country:US
Practice Address - Phone:800-497-0244
Practice Address - Fax:415-353-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0074010Medicaid
CABS531Medicare PIN
CAZZZ14908ZMedicare ID - Type UnspecifiedGROUP ID