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General NPI Number Information
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NPI Number | 1629160858
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Entity Type | Organization
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Legal Business Name | POTOMAC PATHOLOGY CONSULTANTS INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 2500 HOSPITAL DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-3402
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Country | US
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Telephone | 304-264-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1295
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City | BLUEFIELD
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State | WV
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Zip | 24701-1295
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HERNANDO JIMENEZ
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Credential |
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Telephone | 304-264-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology 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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 10129
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License Number State | WV
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