NPIMap

Organization Active NPI

Old Dominion University

  • Clinical Medical Laboratory
  • Norfolk, VA
National Provider Identifier
1952144875
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
OLD DOMINION UNIVERSITY
Practice address
4111 Monarch Way
Room 3104
Norfolk, VA 23508
Phone
(757) 683-5393
NPI assigned
Jun 18, 2024
Organization subpart
Yes
Parent organization
OLD DOMINION UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Dr. Peter Anthony Mollica, PHDNPI 1245911973
Title
Laboratory Director
Phone
(757) 683-3459

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Laboratory Director (Non-physician)Group: 193400000X SINGLE SPECIALTY GROUP 247ZC0005X
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

4111 Monarch Way
Room 3104
Norfolk, VA 23508

Mailing address

4608 Hampton Blvd
2118 Health Sciences BLDG
Norfolk, VA 23508
Phone (757) 683-3247

Other names 1

  • Monarch Molecular Clinical Laboratory Other name

National Provider Directory

National Provider Directory
Tax ID family
Old Dominion University4 organizations share this tax ID, including this one
Part of
Old Dominion University

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4111 Monarch Way
Rm 3104
Norfolk, VA 23508
Phone (757) 683-5393

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1952144875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4608 HAMPTON BLVD",
            "address_2": "2118 HEALTH SCIENCES BLDG",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "23508",
            "telephone_number": "757-683-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 MONARCH WAY",
            "address_2": "ROOM 3104",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "23508",
            "telephone_number": "757-683-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD DOMINION UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OLD DOMINION UNIVERSITY",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "MOLLICA",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "757-683-3459",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "247ZC0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Molecular Clinical Laboratory",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Monarch Molecular Clinical Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.