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General NPI Number Information
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NPI Number | 1821064379
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Entity Type | Organization
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Legal Business Name | NORWICH PATHOLOGY CONSULTANTS, P.C.
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 LAFAYETTE ST SUITE 213
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City | NORWICH
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State | CT
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Zip | 06360-2717
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Country | US
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Telephone | 860-889-4880
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Fax | 860-886-6262
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Provider Business Mailing Address
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Address Line | 18 SEABURY AVE
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City | LEDYARD
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State | CT
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Zip | 06339-1319
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Country | US
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Telephone | 860-464-8422
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | DR. GOWD S. NAGARAJ
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Credential | M.D.
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Telephone | 860-889-4889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 020034
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License Number State | CT
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