Healthcare Provider Details

I. General information

NPI: 1861602898
Provider Name (Legal Business Name): SEACOAST PATHOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIGHLAND AVE
NEWBURYPORT MA
01950-3867
US

IV. Provider business mailing address

PO BOX 100519
ATLANTA GA
30384-0519
US

V. Phone/Fax

Practice location:
  • Phone: 978-463-1000
  • Fax:
Mailing address:
  • Phone: 888-208-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN CHANDLER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 603-778-8522