MEDICARE: BEACON PATHOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1376914531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON PATHOLOGY LLC

Provider Business Mailing Address
First Line	:	35 BROOKFIELD RD
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-1805
Country	:	US
Telephone Number	:	617-314-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 BROOKFIELD RD
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-1805
Country	:	US
Telephone Number	:	617-314-5976
Fax Number	:

Authorized Official
Title or Position	:	MD, OWNER
Name	:	ALIREZA SEPEHR
Credential	:	MD
Telephone Number	:	617-314-5976

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “BEACON PATHOLOGY LLC ” Practice Location

Language	Start Address	Practice Location

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