1508855057 NPI number — PATHOLOGY ASSOCIATES OF NORWOOD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508855057 NPI number — PATHOLOGY ASSOCIATES OF NORWOOD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY ASSOCIATES OF NORWOOD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508855057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 PRINCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-278-6279
Provider Business Mailing Address Fax Number:
781-551-0619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WASHINGTON ST
Provider Second Line Business Practice Location Address:
ATTN PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-769-4000
Provider Business Practice Location Address Fax Number:
781-551-0619
Provider Enumeration Date:
10/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADCOCK
Authorized Official First Name:
LORI
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-278-6279

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9704621 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17675 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 687916 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".