Provider Demographics
NPI:1639185846
Name:PATHOLOGY SPECIALISTS OF NEW ENGLAND,PA
Entity Type:Organization
Organization Name:PATHOLOGY SPECIALISTS OF NEW ENGLAND,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:603-663-2583
Mailing Address - Street 1:291 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:800-688-6663
Mailing Address - Fax:413-589-7554
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2583
Practice Address - Fax:603-663-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81220687Medicaid
CL9337OtherRAILROAD MEDICARE
MANH0687Medicare PIN