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Organization
PROVIDENCE PATHOLOGY ASSOCIATES PA
Active
Organization
PROVIDENCE PATHOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ROBERT MODZELEWSKI M.D. (PRESIDENT)
(803) 256-5335
Entity
Organization
Contact information
Practice address
2435 FOREST DR, C/O PROVIDENCE HOSPITAL, COLUMBIA, SC 29204-2026
(803) 256-5335
(803) 256-5454
Mailing address
PO BOX 30309, CHARLESTON, SC 29417-0309
(843) 554-9300
(843) 556-8780
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
19654
SC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
19654
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2746
—
SC
Enumeration date
02/07/2006
Last updated
01/23/2008
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