Provider Demographics
NPI:1326222696
Name:ARIZONA DIAGNOSTIC PATHOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ARIZONA DIAGNOSTIC PATHOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:RAMA RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-546-0674
Mailing Address - Street 1:3801 N CAMPBELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1448
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:3801 N CAMPBELL AVE STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1448
Practice Address - Country:US
Practice Address - Phone:520-298-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZC0500X
AZ29468207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty