Provider Demographics
NPI:1447585120
Name:CAG GROUP PC
Entity Type:Organization
Organization Name:CAG GROUP PC
Other - Org Name:DERMATOPATHOLOGY CONSULTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-927-7364
Mailing Address - Street 1:7095 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 338
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8903
Mailing Address - Country:US
Mailing Address - Phone:443-927-7364
Mailing Address - Fax:800-419-7485
Practice Address - Street 1:1319 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4104
Practice Address - Country:US
Practice Address - Phone:443-927-7364
Practice Address - Fax:800-419-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D0649684291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory