Provider Demographics
NPI:1255313664
Name:CENTRAL FLORIDA PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-303-6611
Mailing Address - Street 1:PO BOX 140987
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-0987
Mailing Address - Country:US
Mailing Address - Phone:407-422-9831
Mailing Address - Fax:407-648-2065
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:404-303-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN6381OtherRAILROAD MEDICARE
FL253421500Medicaid
CN6381OtherRAILROAD MEDICARE