Healthcare Provider Details

I. General information

NPI: 1841256195
Provider Name (Legal Business Name): NEWTON WELLESLEY PATHOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST DEPARTMENT OF PATHOLOGY
NEWTON MA
02462-1607
US

IV. Provider business mailing address

PO BOX 490940
LAWRENCEVILLE GA
30049-0016
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6140
  • Fax: 617-243-5809
Mailing address:
  • Phone: 770-237-4500
  • Fax: 770-237-4539

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: MICHAEL JAY ROSS
Title or Position: SECRETARY, BOARD OF DIRECTORS
Credential: M.D.
Phone: 617-243-6140