Healthcare Provider Details

I. General information

NPI: 1245302009
Provider Name (Legal Business Name): MID-ATLANTIC PATHOLOGY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 WINDROCK DR
MC LEAN VA
22102-1547
US

IV. Provider business mailing address

1355 RIVER BEND DR
DALLAS TX
75247-4915
US

V. Phone/Fax

Practice location:
  • Phone: 703-404-8189
  • Fax: 703-404-1131
Mailing address:
  • Phone: 214-638-2000
  • Fax: 844-751-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number49D0898222
License Number StateVA

VIII. Authorized Official

Name: DINA VALLADARES
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 954-803-9405