Brevard Pathology PA

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

ME 51687 Issued in FL

Legal business name

BREVARD PATHOLOGY PA

Practice address

8745 N Wickham Rd
Melbourne, FL 32940-5997

Phone

(305) 666-2427

Fax

(305) 667-0239

NPI assigned

May 19, 2011

Organization subpart

No

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

Authorized official

Name

Marco Burenko, MD

Title

President

Phone

(305) 666-2427

Specialties & licenses 1

Addresses

Tax ID family

Brevard Pathology PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brevard Pathology PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Cocoa Beach, FL
  • NPI 1124311964
  NPD tax ID

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1710270095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SAN REMO AVE",
            "address_2": "SUITE 280",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331463043",
            "telephone_number": "305-666-2427",
            "fax_number": "305-666-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8745 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329405997",
            "telephone_number": "305-666-2427",
            "fax_number": "305-667-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD PATHOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "BURENKO",
        "authorized_official_first_name": "MARCO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-666-2427",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME 51687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brevard Neuro Center
• Brevard Optometry Associates
• Brevard Orthopaedic Spine & Pain Clinic Inc
• Brevard Orthopaedic Spine & Pain Clinic Inc
• Brevard Orthopaedics Spine & Pain Clinic, Inc
• Brevard Pathology Services PA
• Brevard Physical Therapy LLC
• Brevard Physician Associates, PLLC
• Brevard Physician Associates, PLLC
• Brevard Primary Care LLC

• All providers in Melbourne, FL
• Anatomic Pathology & Clinical Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.