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General NPI Number Information
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NPI Number | 1063473809
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Entity Type | Organization
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Legal Business Name | CONSULTING PATHOLOGISTS OF CONNECTICUT, P.C.
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 134 GRANDVIEW AVE SUITE 108
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City | WATERBURY
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State | CT
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Zip | 06708-2507
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Country | US
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Telephone | 203-573-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 134 GRANDVIEW AVE SUITE 108
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City | WATERBURY
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State | CT
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Zip | 06708-2507
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Country | US
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Telephone | 203-573-6270
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS ANDERSON
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Credential | M.D.
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Telephone | 203-573-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 23262
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License Number State | CT
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