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General NPI Number Information
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NPI Number | 1710008719
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Entity Type | Organization
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Legal Business Name | CYTODX PHYSICIAN SERVICES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 200 CORPORATE PL SUITE #8
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City | PEABODY
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State | MA
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Zip | 01960-3840
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Country | US
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Telephone | 978-548-5204
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Fax | 978-535-1934
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Provider Business Mailing Address
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Address Line | 200 CORPORATE PL SUITE #8
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City | PEABODY
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State | MA
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Zip | 01960-3840
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Country | US
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Telephone | 978-548-5204
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Fax | 978-535-1934
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PETER MICHAEL MCNICHOLAS
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Credential |
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Telephone | 978-548-5204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State | MA
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Taxonomy #2
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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 | MA
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