NPIMap

Organization Active NPI

Providence Pathology Associates PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Columbia, SC
National Provider Identifier
1780656363
Registry record updated Jan 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
19654 Issued in SC
Legal business name
PROVIDENCE PATHOLOGY ASSOCIATES PA
Practice address
2435 Forest Dr
C/O Providence Hospital
Columbia, SC 29204-2026
Phone
(803) 256-5335
Fax
(803) 256-5454
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2008

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

Authorized official

Name
Dr. Joseph Robert Modzelewski, M.D.
Title
President
Phone
(803) 256-5335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X 19654 SC
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X 19654 SC Primary

Addresses

Primary practice location

2435 Forest Dr
C/O Providence Hospital
Columbia, SC 29204-2026

Mailing address

PO Box 30309
Charleston, SC 29417-0309
Phone (843) 554-9300

Other identifiers 1

IdentifierTypeStateIssuer
GP2746MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1780656363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30309",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294170309",
            "telephone_number": "843-554-9300",
            "fax_number": "843-556-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 FOREST DR",
            "address_2": "C/O PROVIDENCE HOSPITAL",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042026",
            "telephone_number": "803-256-5335",
            "fax_number": "803-256-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PATHOLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "MODZELEWSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-256-5335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "SC",
            "license": "19654",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "19654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2746",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; 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.