Provider Demographics
NPI:1467029785
Name:DERMATOPATHOLOGY SPECIALISTS OF TEXAS
Entity Type:Organization
Organization Name:DERMATOPATHOLOGY SPECIALISTS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-319-6667
Mailing Address - Street 1:9225 MARYMONT PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3421
Mailing Address - Country:US
Mailing Address - Phone:617-319-6667
Mailing Address - Fax:
Practice Address - Street 1:8534 VILLAGE DR FL 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5501
Practice Address - Country:US
Practice Address - Phone:617-319-6667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty