Provider Demographics
NPI:1346658978
Name:CUTANEOUS PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CUTANEOUS PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-404-5066
Mailing Address - Street 1:6 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1480
Mailing Address - Country:US
Mailing Address - Phone:860-404-5066
Mailing Address - Fax:860-404-2931
Practice Address - Street 1:6 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1480
Practice Address - Country:US
Practice Address - Phone:860-404-5066
Practice Address - Fax:860-404-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT31387207ND0900X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89511Medicare UPIN
E79761Medicare UPIN