Organization
EASTSIDE PATHOLOGY INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT D BENJAMIN MD (PRESIDENT)
(425) 646-0922
Entity
Organization
Contact information
Practice address
1280 116TH AVE NE, SUITE 100, BELLEVUE, WA 98004-3803
(425) 646-0922
(425) 646-0925
Mailing address
PO BOX 100559, FLORENCE, SC 29502-0559
(843) 664-4300
(843) 664-4308
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
WA
207ZD0900X
Dermatopathology (Pathology) Physician
—
WA
207ZH0000X
Hematology (Pathology) Physician
—
WA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
WA
291U00000X
Clinical Medical Laboratory
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7045651
—
WA
Enumeration date
05/13/2008
Last updated
06/06/2008
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