1326053919 NPI number — DANVILLE PATHOLOGIST, INC.

Table of content: (NPI 1326053919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326053919 NPI number — DANVILLE PATHOLOGIST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE PATHOLOGIST, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326053919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-799-2100
Provider Business Mailing Address Fax Number:
434-799-2260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-799-8398
Provider Business Practice Location Address Fax Number:
434-799-1415
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARDY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-799-2100

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)