Provider Demographics
NPI:1245239805
Name:DIAGNOSTIC PATHOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OBANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-325-3184
Mailing Address - Street 1:100 BOWMAN DRIVE
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0100
Mailing Address - Country:US
Mailing Address - Phone:856-274-3174
Mailing Address - Fax:
Practice Address - Street 1:100 BOWMAN DRIVE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-0804
Practice Address - Country:US
Practice Address - Phone:856-247-3174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2001257497OtherBLUE CROSS BLUE SHIELD
NJ0036641Medicaid
NJ2001257497OtherBLUE CROSS BLUE SHIELD
DC4529Medicare PIN