Provider Demographics
NPI:1497207559
Name:PATHOLOGY ASSOCIATES OF NORTH FLORIDA
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF NORTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWER
Authorized Official - Prefix:
Authorized Official - First Name:RIZWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-758-6094
Mailing Address - Street 1:4355 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4828
Mailing Address - Country:US
Mailing Address - Phone:386-758-6094
Mailing Address - Fax:386-758-6995
Practice Address - Street 1:4355 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4828
Practice Address - Country:US
Practice Address - Phone:386-758-6094
Practice Address - Fax:386-758-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800027822291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory