Basic Information
| Provider Information | |||||||||
| NPI: | 1952382160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 TOTTEN POND RD | ||||||||
| Address2: | C O MZI | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818909933 | ||||||||
| FaxNumber: | 7818909950 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 N PEARL ST | ||||||||
| Address2: | ATTN PATHOLOGY DEPT | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023011794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084273086 | ||||||||
| FaxNumber: | 5085880520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAKHUJA | ||||||||
| AuthorizedOfficialFirstName: | ROHINI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5084273086 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 42354 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 732320 | 01 | MA | TUFTS | OTHER | 9772804 | 05 | MA | MEDICAID | M15909 | 01 | MA | BCBS | OTHER |