Basic Information
| Provider Information | |||||||||
| NPI: | 1366499733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY SCIENCES MEDICAL GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRESHAM DRIVE | ||||||||
| Address2: | PATHOLOGY DEPT, SENTARA NORFOLK GEN HOSPITAL | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883221 | ||||||||
| FaxNumber: | 7573883799 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DR | ||||||||
| Address2: | SENTARA NORFOLK GEN HOSPITAL PATH DEPT | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883221 | ||||||||
| FaxNumber: | 7573883799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAHHAN | ||||||||
| AuthorizedOfficialFirstName: | HASSAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7573883221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | CE9565 | 01 | VA | RR MEDICARE | OTHER |