Provider Demographics
NPI:1669034518
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARSEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-447-6267
Mailing Address - Street 1:3301 C ST STE 200E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3363
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-456-5842
Practice Address - Street 1:2801 K ST STE 235
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5170
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:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty