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Organization
BREVARD PATHOLOGY SERVICES PA
Active
Organization
BREVARD PATHOLOGY SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES CHODOROW MD (AUTHORIZED OFFICIAL)
(321) 953-4804
Entity
Organization
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 953-4804
(321) 728-7176
Mailing address
2080 S RIVER RD, MELBOURNE BEACH, FL 32951-2928
(321) 953-4804
(321) 728-7176
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
12/15/2014
Last updated
01/02/2015
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