Provider Demographics
NPI:1548270648
Name:HISTO PATH OF AMERICA INC
Entity type:Organization
Organization Name:HISTO PATH OF AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DURKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:HT ASCP
Authorized Official - Phone:410-729-2300
Mailing Address - Street 1:405 HEADQUARTERS DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108
Mailing Address - Country:US
Mailing Address - Phone:410-729-2300
Mailing Address - Fax:410-729-2319
Practice Address - Street 1:405 HEADQUARTERS DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108
Practice Address - Country:US
Practice Address - Phone:410-729-2300
Practice Address - Fax:410-729-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD919246QH0600X
MD246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD060Medicare ID - Type Unspecified