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General NPI Number Information
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NPI Number | 1275590994
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Entity Type | Organization
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Legal Business Name | MLC PATHOLOGY, INC.
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 6 ANGIER RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1609
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Country | US
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Telephone | 781-861-9649
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Fax | 781-863-8031
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Provider Business Mailing Address
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Address Line | 6 ANGIER RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1609
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Country | US
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Telephone | 781-861-9649
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Fax | 781-863-8031
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANLIO (LEO) AUGUSTUS LOCONTE
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Credential | M.D., MPH, FCAP
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Telephone | 781-861-9649
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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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