Provider Demographics
NPI:1376866897
Name:PHYSICIANS DERMPATH LABORATORY
Entity Type:Organization
Organization Name:PHYSICIANS DERMPATH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LORBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-675-9711
Mailing Address - Street 1:1420 N. RENAISSANCE DR.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1330
Mailing Address - Country:US
Mailing Address - Phone:847-768-2440
Mailing Address - Fax:847-768-2443
Practice Address - Street 1:1420 N. RENAISSANCE DR.
Practice Address - Street 2:SUITE 204
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1330
Practice Address - Country:US
Practice Address - Phone:847-768-2440
Practice Address - Fax:847-768-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty