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General NPI Number Information
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NPI Number | 1487105169
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Entity Type | Organization
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Legal Business Name | OSULLIVAN PATHOLOGY PLLC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 4600 SPOTSYLVANIA PKWY
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-7762
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Country | US
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Telephone | 703-257-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 9834 BUSINESS WAY
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City | MANASSAS
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State | VA
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Zip | 20110-4151
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Country | US
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Telephone | 703-257-1440
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Fax | 703-257-4337
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Authorized Official
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Title or Position | OWNER
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Name | EMERALD OSULLIVAN-MEJIA
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Credential | MD
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Telephone | 703-257-1440
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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 | 0101244383
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License Number State | VA
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