Provider Demographics
NPI:1679504351
Name:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-787-1778
Mailing Address - Street 1:5755 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5340
Mailing Address - Country:US
Mailing Address - Phone:866-944-0404
Mailing Address - Fax:
Practice Address - Street 1:1456 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3824
Practice Address - Country:US
Practice Address - Phone:352-787-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9293OtherBCBS OF FL
FLP00321165OtherRAILROAD MEDICARE
FLE9166Medicare PIN