Petersburg Pathology Associates LTD.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

PETERSBURG PATHOLOGY ASSOCIATES LTD.

Practice address

200 Medical Park Blvd
Petersburg, VA 23805-9274

Phone

(804) 765-5026

Fax

(804) 862-5582

NPI assigned

Oct 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brad T Siegmund, MD

Title

Pathologist

Phone

(804) 862-5010

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manuel Borja Gonzales, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Petersburg, VA
  • NPI 1447349444
  NPD
• Edward Peter Nikicicz, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Petersburg, VA
  • NPI 1639267040

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1871679704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8909",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322390909",
            "telephone_number": "804-765-5026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5026",
            "fax_number": "804-862-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG PATHOLOGY ASSOCIATES LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "SIEGMUND",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PATHOLOGIST",
        "authorized_official_telephone_number": "804-862-5010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "055573",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petersburg Hospital Company LLC
• Petersburg Hospital Company LLC
• Petersburg Hospital Company LLC
• Petersburg Hospital Company LLC
• Petersburg Hospital Company LLC
• Petersburg Pharmacy PLLC
• Petersburg Public Schools
• Damon Peterson, M.ED, PBSF
• Tammy Faye Peterson
• Heather M Pettis, M.D.

• Anatomic Pathology & Clinical Pathology Physician in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.