Basic Information
| Provider Information | |||||||||
| NPI: | 1528330644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOPATHOLOGY PARTNERS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888136 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706198 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 FOX RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654748866 | ||||||||
| FaxNumber: | 8655602784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2012 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | NEIL | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8654748866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 1527099 | 05 | TN | MEDICAID |