Pathologists at Riverdale PC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

20216 Issued in GA

Legal business name

PATHOLOGISTS AT RIVERDALE PC

Practice address

11 Upper Riverdale Rd SW
Riverdale, GA 30274-2615

Phone

(813) 490-7206

Fax

(813) 886-6655

NPI assigned

Sep 6, 2016

Last updated

Apr 26, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mario S Gonzalez, MD

Title

President

Phone

(813) 490-7206

Specialties & licenses 1

Addresses

Other names 1

• Pathologists at Riverdale, PC Other name

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

{
    "created_epoch": "1473120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1356898506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 144333",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328144333",
            "telephone_number": "407-422-9831",
            "fax_number": "407-648-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742615",
            "telephone_number": "813-490-7206",
            "fax_number": "813-886-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGISTS AT RIVERDALE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-06",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-490-7206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "20216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathologists at Riverdale, PC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pathologists at Riverdale, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Anatomic Pathology & Clinical Pathology Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.