Provider Demographics
NPI:1578744223
Name:POTTSTOWN PATHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:POTTSTOWN PATHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARZIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:610-327-7238
Mailing Address - Street 1:2 MERIDIAN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-372-4957
Mailing Address - Fax:610-372-3735
Practice Address - Street 1:1600 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5008
Practice Address - Country:US
Practice Address - Phone:610-237-7238
Practice Address - Fax:670-970-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA121059Medicare PIN