Provider Demographics
NPI:1033123377
Name:NORTH COAST PATHOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:NORTH COAST PATHOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-634-3230
Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-5829
Mailing Address - Country:US
Mailing Address - Phone:619-325-8726
Mailing Address - Fax:619-325-8728
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-634-3230
Practice Address - Fax:760-940-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0022390Medicaid
CAZZZ98632ZOtherBLUE SHIELD GROUP NUMBER
CAGR0022390Medicaid
CACP7061Medicare PIN