Healthcare Provider Details

I. General information

NPI: 1295736072
Provider Name (Legal Business Name): LUCIA PASTORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

PO BOX 221322
CHANTILLY VA
20153-1322
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-2746
  • Fax:
Mailing address:
  • Phone: 703-691-2516
  • Fax: 703-691-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number0101032526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: