Basic Information
| Provider Information | |||||||||
| NPI: | 1427567478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARY POROPATICH MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9834 BUSINESS WAY | ||||||||
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| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201104151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032571440 | ||||||||
| FaxNumber: | 7032574337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 N GEORGE MASON DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035585000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2017 | ||||||||
| LastUpdateDate: | 09/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 7032571440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.