Healthcare Provider Details

I. General information

NPI: 1568640886
Provider Name (Legal Business Name): UNIVERSITY PATHOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE RWMC - PATHOLOGY DEPARTMENT
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

67 SLADES FERRY AVE STE 6720
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2662
  • Fax: 401-456-2663
Mailing address:
  • Phone: 401-921-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JILA KHORSAND
Title or Position: MD
Credential:
Phone: 401-921-0252