Provider Demographics
NPI:1821060641
Name:INSTITUTE FOR DERMATOPATHOLOGY, INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR DERMATOPATHOLOGY, INC.
Other - Org Name:AMERIPATH PITTSBURGH, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT/AUTHORIZE OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3003
Mailing Address - Street 1:14275 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:875 GREENTREE ROAD, SUITE 325
Practice Address - Street 2:FOUR PARKWAY CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220
Practice Address - Country:US
Practice Address - Phone:800-845-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0177150291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6701101000Medicaid
VA01016391Medicaid
PA1007508900001Medicaid
OH2335262Medicaid
PA1007508900004Medicaid
PA308055OtherBCBS
VA01016391Medicaid
PA1007508900004Medicaid