Provider Demographics
NPI:1609818954
Name:CENTRAL FLORIDA PATHOLOGY GROUP,P.A.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PATHOLOGY GROUP,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEFTERIOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIKOLAIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-343-3434
Mailing Address - Street 1:2755 S BAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6587
Mailing Address - Country:US
Mailing Address - Phone:352-343-3434
Mailing Address - Fax:352-589-4140
Practice Address - Street 1:1000 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5266
Practice Address - Country:US
Practice Address - Phone:352-253-3374
Practice Address - Fax:352-589-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371153600Medicaid
FL371153600Medicaid