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General NPI Number Information
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NPI Number | 1932424157
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Entity Type | Organization
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Legal Business Name | POTOMAC PATHOLOGY PLLC
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 2300 OPITZ BLVD DEPARTMENT OF PATHOLOGY
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3311
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Country | US
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Telephone | 703-670-1835
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 LOWELL ST NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2749
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Country | US
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Telephone | 202-744-1710
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME THOMAS O'CONNELL JR.
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Credential | M.D.
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Telephone | 703-670-1835
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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 | 0101231713
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License Number State | VA
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