Organization
POTOMAC PATHOLOGY CONSULTANTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERNANDO JIMENEZ (OWNER)
(304) 264-1212
Entity
Organization
Contact information
Practice address
2500 HOSPITAL DR, MARTINSBURG, WV 25401-3402
(304) 264-1000
Mailing address
PO BOX 1295, BLUEFIELD, WV 24701-1295
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
10129
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101738000 - IND.
—
WV
01
—
DG7831
RAILROAD MEDICARE
WV
Enumeration date
09/28/2006
Last updated
09/16/2014
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