# EASTSIDE PATHOLOGY INC PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609830900
- **Authorized official:** DR. BRENT DAVID BENJAMIN M.D. (PRESIDENT)
- **Authorized official phone:** (425) 251-5168

## Contact information

- **Practice address:** 1035 116TH AVE NE, BELLEVUE, WA 98004-4604
- **Practice address phone:** (425) 688-5000
- **Practice address fax:** (425) 688-5959
- **Mailing address:** PO BOX 100559, FLORENCE, SC 29501-0559
- **Mailing address phone:** (843) 664-4300
- **Mailing address fax:** (843) 664-4308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZC0500X | Cytopathology Physician | MD00032601 | WA | — |
| 207ZD0900X | Dermatopathology (Pathology) Physician | MD00032601 | WA | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | MD00041011 | WA | Yes |

## Other

- **Enumeration date:** 04/13/2006
- **Last updated:** 06/06/2008