DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC (AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE) - NPI NUMBER 1548456825

Summary

Provider Name: DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC (AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE)

NPI Number: 1548456825

Clasification: Allergy & Immunology (207K00000X)

Address:
1007 LIVE OAK BLVD
STE A-1
YUBA CITY, CA
ZIP 95991

Phone Number: (530) 673-3790



Detailed Information

DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC is an allergist in Yuba City, CA. The provider is an allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. The assigned NPI number for this provider is 1548456825 and is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As American West Skin Pathology Consultation Service.

The provider's business address is:

1007 LIVE OAK BLVD
STE A-1
YUBA CITY, CA
ZIP 95991-454
Phone: (530) 673-3790
Fax: (530) 673-5642

The provider's authorized official is Leon Melvin Edelstein .
The authorized official title is President and has the following contact phone number (530) 673-3790.

The enumeration date for this NPI number is 9/19/2007 and was last updated on 9/19/2007.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1023177870 DR. LEON MELVIN EDELSTEIN, M.D.
Allergy & Immunology
1184611048 FOY WALLACE COX, M.D.
Allergy & Immunology (Allergy)





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207K00000X Allergy & Immunology 00A192080 CA No
2 207N00000X Dermatology 00A192080 CA No
3 207NP0225X Dermatology Pediatric Dermatology 00A192080 CA No
4 207NS0135X Dermatology Procedural Dermatology 00A192080 CA No
5 207ZD0900X Pathology Dermatopathology 00A192080 CA No
6 207ZI0100X Pathology Immunopathology 00A192080 CA No
7 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology 00A192080 CA No
8 207ZP0213X Pathology Pediatric Pathology 00A192080 CA No
9 208D00000X General Practice 00A192080 CA No
10 209800000X Legal Medicine 00A192080 CA No
11 207ND0900X Dermatology Dermatopathology 00A192080 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 A21651 MEDICARE UPIN CA
2 00A192080 MEDICAID CA
3 ZZZ29262Z MEDICARE OSCAR/CERTIFICATION CA

NPI Record

No. Field Name Field Value
1 NPI 1548456825
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC
5 Provider Other Organization Name AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 1007 LIVE OAK BLVD
8 Provider Second Line Business Practice Location Address STE A-1
9 Provider Business Practice Location Address City Name YUBA CITY
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 959913454
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 5306733790
14 Provider Business Practice Location Address Fax Number 5306735642
15 Provider Enumeration Date 9/19/2007
16 Last Update Date 9/19/2007
17 Authorized Official Last Name EDELSTEIN
18 Authorized Official First Name LEON
19 Authorized Official Middle Name MELVIN
20 Authorized Official Title or Position PRESIDENT
21 Authorized Official Telephone Number 5306733790
22 Healthcare Provider Taxonomy Code 1 207K00000X
23 Provider License Number 1 00A192080
24 Provider License Number State Code 1 CA
25 Healthcare Provider Primary Taxonomy Switch 1 N
26 Healthcare Provider Taxonomy Code 2 207N00000X
27 Provider License Number 2 00A192080
28 Provider License Number State Code 2 CA
29 Healthcare Provider Primary Taxonomy Switch 2 N
30 Healthcare Provider Taxonomy Code 3 207NP0225X
31 Provider License Number 3 00A192080
32 Provider License Number State Code 3 CA
33 Healthcare Provider Primary Taxonomy Switch 3 N
34 Healthcare Provider Taxonomy Code 4 207NS0135X
35 Provider License Number 4 00A192080
36 Provider License Number State Code 4 CA
37 Healthcare Provider Primary Taxonomy Switch 4 N
38 Healthcare Provider Taxonomy Code 5 207ZD0900X
39 Provider License Number 5 00A192080
40 Provider License Number State Code 5 CA
41 Healthcare Provider Primary Taxonomy Switch 5 N
42 Healthcare Provider Taxonomy Code 6 207ZI0100X
43 Provider License Number 6 00A192080
44 Provider License Number State Code 6 CA
45 Healthcare Provider Primary Taxonomy Switch 6 N
46 Healthcare Provider Taxonomy Code 7 207ZP0102X
47 Provider License Number 7 00A192080
48 Provider License Number State Code 7 CA
49 Healthcare Provider Primary Taxonomy Switch 7 N
50 Healthcare Provider Taxonomy Code 8 207ZP0213X
51 Provider License Number 8 00A192080
52 Provider License Number State Code 8 CA
53 Healthcare Provider Primary Taxonomy Switch 8 N
54 Healthcare Provider Taxonomy Code 9 208D00000X
55 Provider License Number 9 00A192080
56 Provider License Number State Code 9 CA
57 Healthcare Provider Primary Taxonomy Switch 9 N
58 Healthcare Provider Taxonomy Code 10 209800000X
59 Provider License Number 10 00A192080
60 Provider License Number State Code 10 CA
61 Healthcare Provider Primary Taxonomy Switch 10 N
62 Healthcare Provider Taxonomy Code 11 207ND0900X
63 Provider License Number 11 00A192080
64 Provider License Number State Code 11 CA
65 Healthcare Provider Primary Taxonomy Switch 11 Y
66 Other Provider Identifier 1 A21651
67 Other Provider Identifier Type Code 1 02
68 Other Provider Identifier State 1 CA
69 Other Provider Identifier 2 00A192080
70 Other Provider Identifier Type Code 2 05
71 Other Provider Identifier State 2 CA
72 Other Provider Identifier 3 ZZZ29262Z
73 Other Provider Identifier Type Code 3 06
74 Other Provider Identifier State 3 CA
75 Is Organization Subpart Y
76 Parent Organization LBN DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC
77 Parent Organization TIN
78 Authorized Official Name Prefix Text DR.
79 Authorized Official Credential Text M.D.
80 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
81 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP
82 Healthcare Provider Taxonomy Group 3 193400000X MULTIPLE SINGLE SPECIALTY GROUP
83 Healthcare Provider Taxonomy Group 4 193400000X MULTIPLE SINGLE SPECIALTY GROUP
84 Healthcare Provider Taxonomy Group 5 193400000X MULTIPLE SINGLE SPECIALTY GROUP
85 Healthcare Provider Taxonomy Group 6 193400000X MULTIPLE SINGLE SPECIALTY GROUP
86 Healthcare Provider Taxonomy Group 7 193400000X MULTIPLE SINGLE SPECIALTY GROUP
87 Healthcare Provider Taxonomy Group 8 193400000X MULTIPLE SINGLE SPECIALTY GROUP
88 Healthcare Provider Taxonomy Group 9 193400000X MULTIPLE SINGLE SPECIALTY GROUP
89 Healthcare Provider Taxonomy Group 10 193400000X MULTIPLE SINGLE SPECIALTY GROUP
90 Healthcare Provider Taxonomy Group 11 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.