Provider Demographics
NPI:1750380879
Name:DOMINION PATHOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:DOMINION PATHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-981-7271
Mailing Address - Street 1:PO BOX 746167
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6167
Mailing Address - Country:US
Mailing Address - Phone:540-581-0155
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERSIDE CIR STE 105
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4961
Practice Address - Country:US
Practice Address - Phone:540-581-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH7207OtherRAILROAD MEDICARE
WV0202697000Medicaid
020260000OtherFEDERAL BLACK LUNG