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General NPI Number Information
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NPI Number | 1184655706
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Entity Type | Organization
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Legal Business Name | PATHOLOGY CONSULTANTS OF NEW LONDON, P.C.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 365 MONTAUK AVE
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City | NEW LONDON
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State | CT
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Zip | 06320-4700
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Country | US
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Telephone | 860-444-5100
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Fax | 860-444-3709
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | NEW HAVEN
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State | CT
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Zip | 06504-0902
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Country | US
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Telephone | 203-397-8000
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Fax | 203-389-1540
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA VICTORIA G REYES
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Credential | M.D.
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Telephone | 203-397-8000
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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 |
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License Number State |
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