Provider Demographics
NPI:1760454987
Name:SOUTHEAST MASS. PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:SOUTHEAST MASS. PATHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLBARSHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-679-7398
Mailing Address - Street 1:363 HIGHLAND AVE
Mailing Address - Street 2:CHARLTON HOSPITAL
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3703
Mailing Address - Country:US
Mailing Address - Phone:508-679-7398
Mailing Address - Fax:
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:CHARLTON HOSPITAL
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-679-7398
Practice Address - Fax:781-380-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779817Medicaid
RISE20320Medicaid
RISE20320Medicaid