Provider Demographics
NPI:1275590994
Name:MLC PATHOLOGY, INC.
Entity Type:Organization
Organization Name:MLC PATHOLOGY, INC.
Other - Org Name:LEO LO CONTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANLIO (LEO)
Authorized Official - Middle Name:AUGUSTUS
Authorized Official - Last Name:LOCONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FCAP
Authorized Official - Phone:781-861-9649
Mailing Address - Street 1:6 ANGIER RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1609
Mailing Address - Country:US
Mailing Address - Phone:781-861-9649
Mailing Address - Fax:781-863-8031
Practice Address - Street 1:6 ANGIER RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1609
Practice Address - Country:US
Practice Address - Phone:781-861-9649
Practice Address - Fax:781-863-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
102055200OtherFEDERAL WORKERS COMP
22D0650118OtherCLIA
MAM16670OtherBLUE CROSS
MA612830OtherTUFTS
MA9782737Medicaid
DA4871OtherRAILROAD MEDICARE
MA9782737Medicaid
=========OtherTRICARE