MEDICARE: MID-ATLANTIC PATHOLOGY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
2	291U00000X	Clinical Medical Laboratory	49D0898222	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	690007157	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B020	OTHER	VA	CAREFIRST BLUE CROSS DC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	200330	OTHER	VA	ANTHEM BLUE CROSS
5	6902000000KU90	OTHER	VA	CAREFIRST NATIONAL ACCTS
6	KU90MI	OTHER	VA	CAREFIRST OF MARYLAND
7	137554	OTHER	VA	SOUTHERN HEALTHCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245302009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC PATHOLOGY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1355 RIVER BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4915
Country	:	US
Telephone Number	:	214-638-2000
Fax Number	:	844-751-9262

Provider Business Practice Location Address
First Line	:	1171 WINDROCK DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-1547
Country	:	US
Telephone Number	:	703-404-8189
Fax Number	:	703-404-1131

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	DINA VALLADARES
Credential	:
Telephone Number	:	954-803-9405

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/07/2026

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