Healthcare Provider Details

I. General information

NPI: 1306768858
Provider Name (Legal Business Name): METIRRA PATHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10128 W BROAD ST STE H
GLEN ALLEN VA
23060-6761
US

IV. Provider business mailing address

2889 W ASHTON BLVD STE 300
LEHI UT
84048-4968
US

V. Phone/Fax

Practice location:
  • Phone: 949-616-2809
  • Fax:
Mailing address:
  • Phone: 949-616-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN C HENDRICK
Title or Position: EVP COMMERCIAL
Credential:
Phone: 949-616-2809