Organization
CUTANEOUS AND MAXILLOFACIAL PATHOLOGY LABORATORY, PC
Active
Other names
Dermatopathology Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY D. LYNN (BILLING CLERK)
(317) 843-2204
Entity
Organization
Contact information
Practice address
9292 N. MERIDIAN ST., SUITE 210, INDIANAPOLIS, IN 46260-1828
(317) 843-2204
(317) 843-2478
Mailing address
9292 N. MERIDIAN ST., SUITE 210, INDIANAPOLIS, IN 46260-1828
(317) 843-2204
(317) 843-2478
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0647261
IN
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100236370A
—
IN
Enumeration date
11/15/2006
Last updated
06/10/2019
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