1548339682 NPI number — VIRGINIA PATHOLOGY SVCS PC

Table of content: (NPI 1548339682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548339682 NPI number — VIRGINIA PATHOLOGY SVCS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA PATHOLOGY SVCS PC
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:
1548339682
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:
6121 LINCOLNIA RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-256-2962
Provider Business Mailing Address Fax Number:
703-256-3608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6121 LINCOLNIA RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-256-2962
Provider Business Practice Location Address Fax Number:
703-256-3608
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROUSHDY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
GREISS
Authorized Official Title or Position:
DR PRESIDENT
Authorized Official Telephone Number:
703-256-2962

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  0101033048 , 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: 284543 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6365 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 6605435 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OR66MG . This is a "BC-BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 92412 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9845919 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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