Provider Demographics
NPI:1982002473
Name:BREVARD PATHOLOGY SERVICES PA
Entity Type:Organization
Organization Name:BREVARD PATHOLOGY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODOROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-953-4804
Mailing Address - Street 1:2080 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2928
Mailing Address - Country:US
Mailing Address - Phone:321-953-4804
Mailing Address - Fax:321-728-7176
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-953-4804
Practice Address - Fax:321-728-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty