Provider Demographics
NPI:1073626743
Name:VIRGINIA LABORATORY SERVICES, LLC
Entity Type:Organization
Organization Name:VIRGINIA LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO-GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-829-4153
Mailing Address - Street 1:9834 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4151
Mailing Address - Country:US
Mailing Address - Phone:037-257-1440
Mailing Address - Fax:703-257-4337
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:540-829-4153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073626743OtherNPI GROUP
VA1073626743OtherNPI GROUP
VA1629067491OtherINDIVIDUAL NPI
E92909Medicare UPIN
VA1073626743OtherNPI GROUP
VA1629067491OtherINDIVIDUAL NPI