Provider Demographics
NPI:1578960043
Name:BESTGATE PATHOLOGY LAB
Entity Type:Organization
Organization Name:BESTGATE PATHOLOGY LAB
Other - Org Name:ANNE ARUNDEL GASTROENTEROLOGY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-837-2011
Mailing Address - Street 1:820 BESTGATE RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-4960
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3404
Practice Address - Country:US
Practice Address - Phone:410-224-2118
Practice Address - Fax:410-224-2118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL GASTROENTEROLOGY ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D0219800291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory