Provider Demographics
NPI:1457677270
Name:CLINICAL PATHOLOGY CONSULTANTS OF SOUTHERN CONNECTICUT, LLC
Entity Type:Organization
Organization Name:CLINICAL PATHOLOGY CONSULTANTS OF SOUTHERN CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARASWATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-852-2652
Mailing Address - Street 1:P.O. BOX 1909
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06509
Mailing Address - Country:US
Mailing Address - Phone:203-852-2649
Mailing Address - Fax:
Practice Address - Street 1:35 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06856
Practice Address - Country:US
Practice Address - Phone:203-852-2649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4064515Medicaid
CTA687787OtherOXFORD
CT061113482OtherMULTIPLAN
CT500HBL073CT01OtherBLUE CROSS
CT713482OtherCONNECTICARE
CT0063241OtherUS HEALTHCARE
CT0582874OtherCIGNA
CTC00502OtherMEDICARE
CT022040OtherHEALTHNET
0063241OtherAETNA
CT061113482OtherUNITED HEALTHCARE