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Organization
SEACOAST PATHOLOGY, INC.
Active
Organization
SEACOAST PATHOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C. GRATTENDICK (VICE PRESIDENT)
(561) 626-5512
Entity
Organization
Contact information
Practice address
5 ALUMNI DR, EXETER, NH 03833-2128
(603) 778-8522
Mailing address
11025 RCA CENTER DR, SUITE 300, PALM BEACH GARDENS, FL 33410-4269
(561) 626-5512
(561) 626-4530
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202050900
FED WORKERS COMP
—
01
—
406
HEALTHSOURCE
—
01
—
600310
TUFTS
—
01
—
60510
AETNA/USHEALTH
—
05
—
81223726
—
NH
05
—
9701478
—
MA
01
—
CB4418
RAILROAD MEDICARE
NH
Enumeration date
11/29/2005
Last updated
03/16/2016
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