Provider Demographics
NPI:1184655706
Name:PATHOLOGY CONSULTANTS OF NEW LONDON, P.C.
Entity Type:Organization
Organization Name:PATHOLOGY CONSULTANTS OF NEW LONDON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA VICTORIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-397-8000
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06504-0902
Mailing Address - Country:US
Mailing Address - Phone:203-397-8000
Mailing Address - Fax:203-389-1540
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-444-5100
Practice Address - Fax:860-444-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT032344OtherHEALTHNET GROUP#
CT2116927OtherAETNA/US HLTH GROUP#
CT004121133Medicaid
CT744026OtherCONNECTICARE GROUP#
CT500HBL160CT01OtherBC/BS GROUP#
CT3193248OtherCIGNA GROUP#
CTC009155OtherTRI-CARE/CHAMPUS GROUP#
CT032344OtherHEALTHNET GROUP#
CT500HBL160CT01OtherBC/BS GROUP#
CT744026OtherCONNECTICARE GROUP#
CT=========OtherFEDERAL BC/BS