Provider Demographics
NPI:1821064379
Name:NORWICH PATHOLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:NORWICH PATHOLOGY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOWD
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-4889
Mailing Address - Street 1:18 SEABURY AVE
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1319
Mailing Address - Country:US
Mailing Address - Phone:860-464-8422
Mailing Address - Fax:
Practice Address - Street 1:120 LAFAYETTE ST
Practice Address - Street 2:SUITE 213
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2717
Practice Address - Country:US
Practice Address - Phone:860-889-4880
Practice Address - Fax:860-886-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00159Medicare ID - Type Unspecified
CTB39106Medicare UPIN