MEDICARE: DOMINION PATHOLOGY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH7207	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	020260000	OTHER		FEDERAL BLACK LUNG

General Provider Information

NPI Number	:	1750380879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION PATHOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	PO BOX 746167
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6167
Country	:	US
Telephone Number	:	540-581-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RIVERSIDE CIR STE 105
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4961
Country	:	US
Telephone Number	:	540-581-0155
Fax Number	:

Authorized Official
Title or Position	:	PATHOLOGIST PRESIDENT
Name	:	DR. BRIAN KEITH NEWMAN
Credential	:	MD
Telephone Number	:	540-981-7271

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/20/2023

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Directions to “DOMINION PATHOLOGY ASSOCIATES PC ” Practice Location

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