Provider Demographics
NPI:1346404753
Name:CLINICAL PATHOLOGY ASSOCIATES OF FREDERICKSBURG LLC
Entity Type:Organization
Organization Name:CLINICAL PATHOLOGY ASSOCIATES OF FREDERICKSBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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:PO BOX 822803
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2803
Mailing Address - Country:US
Mailing Address - Phone:800-664-3939
Mailing Address - Fax:
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:540-741-1130
Practice Address - Fax:540-741-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029603291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory