Provider Demographics
NPI:1952680308
Name:DANVILLE PATHOLOGISTS, INC
Entity Type:Organization
Organization Name:DANVILLE PATHOLOGISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-799-3807
Mailing Address - Street 1:212 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2943
Mailing Address - Country:US
Mailing Address - Phone:434-799-8398
Mailing Address - Fax:434-799-1415
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2943
Practice Address - Country:US
Practice Address - Phone:434-799-8398
Practice Address - Fax:434-799-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055196291U00000X
VA0101030846291U00000X
VA0101017703291U00000X
VA0101017161291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225043821OtherMEDICARE NPI
VA1538151196Medicaid
VA6649084Medicaid
VA1538151196OtherMEDICARE NPI
VA1598953861OtherMEDICARE,NPI
VA6649181Medicaid
VA1326053919OtherMEDICARE,NPI
VA1285640722OtherMEDIARE NPI
VA6649168Medicaid