1356482517 NPI number — WASHINGTON PATHOLOGY SERVICES., INC

Table of content: (NPI 1356482517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356482517 NPI number — WASHINGTON PATHOLOGY SERVICES., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON PATHOLOGY SERVICES., 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:
1356482517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LAWYERS RD, N.W
Provider Second Line Business Mailing Address:
#1455
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22183-8071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-255-5504
Provider Business Mailing Address Fax Number:
703-255-5507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 MAPLE AVE W
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22180-5614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-255-5504
Provider Business Practice Location Address Fax Number:
703-255-5507
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OCAMPO
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-255-5504

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  0101030967 , 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)

  • Identifier: W431 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1491 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201793 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: W1H12 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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