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General NPI Number Information
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NPI Number | 1245302009
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC PATHOLOGY SERVICES, INC.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 405 GLENN DR SUITE 10-A
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City | STERLING
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State | VA
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Zip | 20164-7119
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Country | US
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Telephone | 703-404-8189
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Fax | 703-404-1131
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Provider Business Mailing Address
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Address Line | 1355 RIVER BEND DR
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City | DALLAS
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State | TX
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Zip | 75247-4915
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Country | US
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Telephone | 214-638-2000
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Fax | 844-751-9262
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL C. GRATTENDICK
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Credential |
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Telephone | 561-626-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 49D0898222
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License Number State | VA
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