Provider Demographics
NPI:1699181669
Name:PLATINUM PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:PLATINUM PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHANDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-420-8243
Mailing Address - Street 1:8000 VIRGINIA MANOR RD STE 170
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4230
Mailing Address - Country:US
Mailing Address - Phone:862-298-5960
Mailing Address - Fax:301-259-5781
Practice Address - Street 1:10128 W BROAD ST
Practice Address - Street 2:SUITE H
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:706-373-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS4879708291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory