Provider Demographics
NPI:1558326991
Name:EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT PATHOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-647-6487
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06501-0206
Mailing Address - Country:US
Mailing Address - Phone:203-397-8000
Mailing Address - Fax:203-389-1540
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6487
Practice Address - Fax:860-647-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
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
CT500HBL161CT01OtherBLUE CROSS GROUP #
CTC009784OtherCHAMPUS TRICARE
CTOR4388OtherHEALTHNET
CT4126521Medicaid
CT76164901OtherCONNECTICARE
CT500HBL161CT02OtherBLUE CROSS GRP ROCKVILLE
CTW1H29OtherEMPIRE BC/BS
CT1104296OtherUHC
CTA524580OtherOXFORD
CT4126521Medicaid