Healthcare Provider Details

I. General information

NPI: 1144219940
Provider Name (Legal Business Name): DEBORAH GORDON WACHUSETT PATHOLOGISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN ST
GARDNER MA
01440-1336
US

IV. Provider business mailing address

PO BOX 2200
AMHERST NH
03031-4200
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-6256
  • Fax:
Mailing address:
  • Phone: 603-673-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DEBORAH GORDON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-630-6256