Provider Demographics
NPI:1255582383
Name:DERMATOPATHOLOGY SPECIALISTS
Entity type:Organization
Organization Name:DERMATOPATHOLOGY SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-284-4798
Mailing Address - Street 1:570 LONG POINT RD SUITE 230
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-284-4799
Mailing Address - Fax:843-284-4796
Practice Address - Street 1:1280 JOHNNIE DODDS BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3285
Practice Address - Country:US
Practice Address - Phone:843-284-4799
Practice Address - Fax:843-284-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC291U00000X, 207ZP0102X
SC8871207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2283Medicaid
SCL00252Medicaid
D05518Medicare UPIN
SCL00252Medicaid