Provider Demographics
NPI:1568637932
Name:PALM BEACH PATHOLOGY PA
Entity Type:Organization
Organization Name:PALM BEACH PATHOLOGY PA
Other - Org Name:MARTIN PATHOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-240-9555
Mailing Address - Street 1:PO BOX 4117
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33402-4117
Mailing Address - Country:US
Mailing Address - Phone:954-240-9555
Mailing Address - Fax:770-776-5966
Practice Address - Street 1:300 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2338
Practice Address - Country:US
Practice Address - Phone:954-240-9555
Practice Address - Fax:770-776-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77313OtherBLUE CROSS BLUE SHIELD
FL258264300Medicaid
FL77313OtherBLUE CROSS BLUE SHIELD
CG3589Medicare PIN
FL77313OtherBLUE CROSS BLUE SHIELD