Provider Demographics
NPI:1154499986
Name:THE PATHOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:THE PATHOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:KINDIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-626-1409
Mailing Address - Street 1:69 LOVEJOY POND RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:ME
Mailing Address - Zip Code:04284-3337
Mailing Address - Country:US
Mailing Address - Phone:207-685-4382
Mailing Address - Fax:207-685-4206
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-626-1409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME006896291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME006896OtherMAINE BOARD OF LICENSURE
ME006896OtherMAINE BOARD OF LICENSURE