Gidwani Pathology

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

ME109293 Issued in FL

Legal business name

GIDWANI PATHOLOGY

Practice address

3950 Hollywood Blvd
Suite 201-C
Hollywood, FL 33021

Phone

(844) 443-9264

Fax

(844) 443-9264

NPI assigned

Mar 2, 2016

Organization subpart

No

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

Authorized official

Name

Raja M Gidwani, M.D.

Title

President/Physician

Phone

(844) 443-9264

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1174983266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 SW 186TH WAY",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330292720",
            "telephone_number": "844-443-9264",
            "fax_number": "844-443-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 HOLLYWOOD BLVD",
            "address_2": "SUITE 201-C",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "844-443-9264",
            "fax_number": "844-443-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIDWANI PATHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "GIDWANI",
        "authorized_official_first_name": "RAJA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "844-443-9264",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "ME109293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "800028089",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003414400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniela Ghessi
• Peter Giacoma IV
• Adrianne Elizabeth Gibbs-Phagan, M.D.
• Leisa Monique Gibson
• Odessa Odara Gibson, RN
• Fernanda Lucia Giha
• Jose Gil Molina
• Karla Sylvia Gil, MD
• Gilah Weissman, Arnp, PLLC
• Gilbert Medical Group Inc (ConciergeMD)

• Clinical Medical Laboratory in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.