Basic Information
| Provider Information | |||||||||
| NPI: | 1396984712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIBIASIO | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MT(ASCP) | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | THOMAS | ||||||||
| OtherFirstName: | BETH | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherCredential: | MT(ASCP) | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16310 SW 60TH PL | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344815318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522096165 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4800 SW 35TH DR | ||||||||
| Address2: | CORE LAB, RM 1106 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650680 | ||||||||
| FaxNumber: | 3522659971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2009 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246QL0900X | SU26859 | FL | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Pathology | Laboratory Management |
No ID Information.