NPIMap

Organization Active NPI

Suncoast Dermpath Laboratory & Consultation, LLC

  • Dermatopathology Physician
  • Tampa, FL
National Provider Identifier
1013239219
Registry record updated Sep 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
ME99158 Issued in FL
Legal business name
SUNCOAST DERMPATH LABORATORY & CONSULTATION, LLC
Practice address
4431 Waltham Dr
Tampa, FL 33634-7345
Phone
(813) 598-2893
Fax
(888) 427-8643
NPI assigned
Feb 16, 2010
Last updated
Sep 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shurun Zhao, M.D.NPI 1578603767
Title
President
Phone
(813) 598-2893

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X ME99158 FL Primary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X ME99158 FL

Addresses

Primary practice location

4431 Waltham Dr
Tampa, FL 33634-7345

Mailing address

4431 Waltham Dr
Tampa, FL 33634-7345
Phone (813) 598-2893

Other identifiers 1

IdentifierTypeStateIssuer
280544800MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314921600000",
    "number": "1013239219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4431 WALTHAM DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347345",
            "telephone_number": "813-598-2893",
            "fax_number": "888-427-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4431 WALTHAM DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347345",
            "telephone_number": "813-598-2893",
            "fax_number": "888-427-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST DERMPATH LABORATORY & CONSULTATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-16",
        "last_updated": "2011-09-02",
        "status": "A",
        "authorized_official_last_name": "ZHAO",
        "authorized_official_first_name": "SHURUN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-598-2893",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "FL",
            "license": "ME99158",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME99158",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280544800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.