Organization
PROTEAN PATHOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY MAGLIOCCO MD (MANAGING DIRECTOR)
(813) 817-2042
Entity
Organization
Contact information
Practice address
6555 SANGER RD STE 260, ORLANDO, FL 32827-7686
(754) 242-9682
(813) 694-7006
Mailing address
6555 SANGER RD STE 260, ORLANDO, FL 32827-7686
(754) 242-9682
(813) 694-7006
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207ZC0500X
Cytopathology Physician
—
—
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
—
—
207ZP0101X
Anatomic Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O4QJT
FLORIDA BLUE
—
Enumeration date
05/26/2022
Last updated
12/30/2022
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