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NPI Code Detail

MEDICARE: MID-ATLANTIC PATHOLOGY SERVICES, INC

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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number : 1578308334
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 : 954-803-9405
Fax Number :
Provider Business Practice Location Address
First Line : 706 GREEN VALLEY RD STE 104
Second Line :
City : GREENSBORO
State : NC
Zip : 27408-7043
Country : US
Telephone Number : 703-404-8189
Fax Number :
Authorized Official
Title or Position : CFO
Name : MICHAEL GRATTENDICK
Credential :
Telephone Number : 954-803-9405
Provider Enumeration Date : 06/25/2024
Last Update Date : 06/25/2024

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Directions to “MID-ATLANTIC PATHOLOGY SERVICES, INC ” Practice Location

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