Provider Demographics
NPI:1336119882
Name:GAINESVILLE PATHOLOGY GROUP
Entity Type:Organization
Organization Name:GAINESVILLE PATHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GAINESVILLE PATHOLOGY GRO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-338-6740
Mailing Address - Street 1:801 SW 2ND AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6210
Mailing Address - Country:US
Mailing Address - Phone:352-338-6740
Mailing Address - Fax:
Practice Address - Street 1:801 SW 2ND AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6210
Practice Address - Country:US
Practice Address - Phone:352-338-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
Not Answered207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39024Medicare ID - Type Unspecified