Provider Demographics
NPI:1528078813
Name:SURGICAL PATHOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:SURGICAL PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-723-0070
Mailing Address - Street 1:207 GEORGETOWN WRIGHTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-2520
Mailing Address - Country:US
Mailing Address - Phone:609-723-0070
Mailing Address - Fax:609-723-0073
Practice Address - Street 1:207 GEORGETOWN WRIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562-2520
Practice Address - Country:US
Practice Address - Phone:609-723-0070
Practice Address - Fax:609-723-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA00747300174400000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2359692000OtherAMERIHEALTH
DD1085OtherRR MEDICARE
NJ0051543Medicaid
NJ5001537OtherGHI
OK100745580AMedicaid
DD1085OtherRR MEDICARE
OKG20266Medicare UPIN
OK731498545Medicare PIN