Provider Demographics
NPI:1639166549
Name:DERMATOPATHOLOGY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:DERMATOPATHOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-310-1080
Mailing Address - Street 1:1409 STOCKTON RD
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1130
Mailing Address - Country:US
Mailing Address - Phone:215-886-4272
Mailing Address - Fax:856-310-1081
Practice Address - Street 1:104 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1908
Practice Address - Country:US
Practice Address - Phone:856-310-1080
Practice Address - Fax:856-310-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07850300291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI27779Medicare UPIN
NJ08009Medicare ID - Type UnspecifiedPROVIDER NUMBER