Provider Demographics
NPI:1750417044
Name:CHILDREN'S PATHOLOGY CONSULTANTS MEDICAL CORP., INC.
Entity type:Organization
Organization Name:CHILDREN'S PATHOLOGY CONSULTANTS MEDICAL CORP., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF DEPT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-428-3162
Mailing Address - Street 1:252 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2310
Mailing Address - Country:US
Mailing Address - Phone:510-428-3162
Mailing Address - Fax:510-601-3915
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3530
Practice Address - Fax:510-601-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64565207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64565OtherDR ROWLAND'S CA MD LICENS