Healthcare Provider Details
I. General information
NPI: 1346363215
Provider Name (Legal Business Name): EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/07/2007
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
31 UNION ST
VERNON CT
06066-3126
US
IV. Provider business mailing address
PO BOX 206
NEW HAVEN CT
06501-0206
US
V. Phone/Fax
- Phone: 860-872-5236
- Fax:
- Phone: 203-397-8000
- Fax: 203-389-1540
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207ZP0102X |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DENNIS
G
O'NEILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 860-647-6487