Basic Information
| Provider Information | |||||||||
| NPI: | 1891229720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-ATLANTIC PATHOLOGY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11025 RCA CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104269 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 GLENN DR | ||||||||
| Address2: | SUITE 10A | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201647119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034048189 | ||||||||
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| ProviderEnumerationDate: | 04/18/2017 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | HAAS | ||||||||
| AuthorizedOfficialFirstName: | MARCI | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 5615147322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.