Provider Demographics
NPI:1114032976
Name:COMMONWEALTH PATHOLOGY PARTNERS, P.C.
Entity Type:Organization
Organization Name:COMMONWEALTH PATHOLOGY PARTNERS, P.C.
Other - Org Name:NORTH SHORE PATHOLOGIST, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-243-6234
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0164
Mailing Address - Country:US
Mailing Address - Phone:800-214-2888
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-354-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067978AMedicaid
MA9714341Medicaid