Provider Demographics
NPI:1568400489
Name:ADVANCED PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CACCIABEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-826-6000
Mailing Address - Street 1:PO BOX 79906
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0906
Mailing Address - Country:US
Mailing Address - Phone:240-364-2515
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-364-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCI1446OtherRAILROAD GRP. #
MD900102600Medicaid
MD900102600Medicaid