Provider Demographics
NPI:1770064271
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,PHD
Authorized Official - Phone:916-447-6267
Mailing Address - Street 1:3301 C ST
Mailing Address - Street 2:SUITE 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:916-456-5842
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:BLDGE E STE 106
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
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:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty