Provider Demographics
NPI:1417391749
Name:CONSOLIDATED DERMPATH INC
Entity Type:Organization
Organization Name:CONSOLIDATED DERMPATH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-257-0117
Mailing Address - Street 1:895 SW 30TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4887
Mailing Address - Country:US
Mailing Address - Phone:866-836-7136
Mailing Address - Fax:954-633-3397
Practice Address - Street 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:800-330-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800001294291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory