1699181669 NPI number — PLATINUM PATHOLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699181669 NPI number — PLATINUM PATHOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLATINUM PATHOLOGY, PLLC
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:
1699181669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 VIRGINIA MANOR RD STE 170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-4230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-298-5960
Provider Business Mailing Address Fax Number:
301-259-5781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10128 W BROAD ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-373-1771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOTHANDARAM
Authorized Official First Name:
SATHISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
855-420-8243

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  S4879708 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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