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General NPI Number Information
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NPI Number | 1972909497
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Entity Type | Organization
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Legal Business Name | PENINSULA PATHOLOGY ASSOCIATES OF VIRGINIA PLLC
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 500 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1929
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Country | US
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Telephone | 757-594-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19100
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City | ROANOKE
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State | VA
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Zip | 24019-1010
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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 | PRESIDENT
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Name | DAVID M SMITH
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Credential | MD
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Telephone | 757-594-2867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 0101054006
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License Number State | VA
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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 | 0101054006
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License Number State | VA
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