Healthcare Provider Details

I. General information

NPI: 1487687927
Provider Name (Legal Business Name): CARY O POROPATICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR PATHOLOGY DEPT
ARLINGTON VA
22205-3683
US

IV. Provider business mailing address

PO BOX 7308
ARLINGTON VA
22207-0308
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6541
  • Fax: 502-456-4440
Mailing address:
  • Phone: 800-292-1387
  • Fax: 502-456-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101-042608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: