Provider Demographics
NPI:1366499733
Name:PATHOLOGY SCIENCES MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:PATHOLOGY SCIENCES MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAHHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-388-3221
Mailing Address - Street 1:600 GRESHAM DRIVE
Mailing Address - Street 2:PATHOLOGY DEPT, SENTARA NORFOLK GEN HOSPITAL
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3221
Mailing Address - Fax:757-388-3799
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:SENTARA NORFOLK GEN HOSPITAL PATH DEPT
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3221
Practice Address - Fax:757-388-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACE9565OtherRR MEDICARE
VACE9565OtherRR MEDICARE