Provider Demographics
NPI:1184709313
Name:DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-446-0424
Mailing Address - Street 1:3301 C ST
Mailing Address - Street 2:#200E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3300
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-447-0621
Practice Address - Street 1:2825 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95616-5616
Practice Address - Country:US
Practice Address - Phone:916-447-6267
Practice Address - Fax:916-456-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184709313Medicaid
CACS7233OtherMEDICARE RAILROAD
CA1184709313Medicaid