NPIMap

Organization Active NPI

Protean Pathology Services LLC

  • Anatomic Pathology Physician
  • Orlando, FL
National Provider Identifier
1285372490
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
Legal business name
PROTEAN PATHOLOGY SERVICES LLC
Practice address
6555 Sanger Rd Ste 260
Orlando, FL 32827-7686
Phone
(754) 242-9682
Fax
(813) 694-7006
NPI assigned
May 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Authorized official

Name
Dr. Anthony Magliocco, MD
Title
Managing Director
Phone
(813) 817-2042

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207SG0201X
Cytopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZC0500X
Molecular Genetic Pathology (Pathology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0007X
Anatomic Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0101X Primary

Addresses

Primary practice location

6555 Sanger Rd Ste 260
Orlando, FL 32827-7686

Mailing address

6555 Sanger Rd Ste 260
Orlando, FL 32827-7686
Phone (754) 242-9682

Other identifiers 1

IdentifierTypeStateIssuer
O4QJTOtherFLORIDA BLUE

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1285372490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6555 SANGER RD STE 260",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277686",
            "telephone_number": "754-242-9682",
            "fax_number": "813-694-7006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 SANGER RD STE 260",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277686",
            "telephone_number": "754-242-9682",
            "fax_number": "813-694-7006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTEAN PATHOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "MAGLIOCCO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "813-817-2042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "O4QJT",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.