Healthcare Provider Details

I. General information

NPI: 1952386245
Provider Name (Legal Business Name): ATLANTIC PATHOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

PO BOX 1849
LEWISTON ME
04241-1948
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-4907
  • Fax: 603-499-4910
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SONYA M SCHWAEGERLE
Title or Position: PRESIDENT
Credential: MD
Phone: 603-433-4907