Provider Demographics
NPI:1417264011
Name:ACCESS DERMPATH INC
Entity Type:Organization
Organization Name:ACCESS DERMPATH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-536-9270
Mailing Address - Street 1:3705 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7950
Mailing Address - Country:US
Mailing Address - Phone:352-536-9270
Mailing Address - Fax:352-536-9279
Practice Address - Street 1:4805 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4141
Practice Address - Country:US
Practice Address - Phone:352-536-9270
Practice Address - Fax:525-369-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2009723291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory