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General NPI Number Information
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NPI Number | 1700878238
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Entity Type | Organization
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Legal Business Name | MONUMENT PATHOLOGISTS INC
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 5801 BREMO RD
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City | RICHMOND
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State | VA
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Zip | 23226-1907
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Country | US
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Telephone | 804-764-6881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 91726
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City | RICHMOND
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State | VA
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Zip | 23291-1726
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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 | DIRECTOR
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Name | DR. JACK WILSON
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Credential | MD
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Telephone | 630-472-8800
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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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