Organization
GIDWANI PATHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJA M GIDWANI M.D. (PRESIDENT/PHYSICIAN)
(844) 443-9264
Entity
Organization
Contact information
Practice address
3950 HOLLYWOOD BLVD, SUITE 201-C, HOLLYWOOD, FL 33021
(844) 443-9264
(844) 443-9264
Mailing address
3920 SW 186TH WAY, MIRAMAR, FL 33029-2720
(844) 443-9264
(844) 443-9264
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
ME109293
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003414400
—
FL
01
—
800028089
CLIA
FL
Enumeration date
03/02/2016
Last updated
04/21/2016
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