Provider Demographics
NPI:1033150982
Name:PATHOLOGY ASSOCIATES OF FREDERICKSBURG PTR
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF FREDERICKSBURG PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-741-1130
Mailing Address - Street 1:1001 SAM PERRY BLVD
Mailing Address - Street 2:MARY WASHINGTON HOSPITAL
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4453
Mailing Address - Country:US
Mailing Address - Phone:540-741-1130
Mailing Address - Fax:540-741-1142
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-1168
Practice Address - Fax:540-741-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007031OtherBCBS
VAC01346Medicare ID - Type Unspecified