Provider Demographics
NPI:1013906650
Name:WINCHESTER LABORATORY ASSOCIATES INC
Entity Type:Organization
Organization Name:WINCHESTER LABORATORY ASSOCIATES INC
Other - Org Name:WINCHESTER LABORATORY ASSOCIATES PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-965-2822
Mailing Address - Street 1:PO BOX 532283
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2283
Mailing Address - Country:US
Mailing Address - Phone:800-325-7284
Mailing Address - Fax:205-579-9387
Practice Address - Street 1:41 HIGHLAND AVE
Practice Address - Street 2:WINCHESTER HOSPITAL
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1446
Practice Address - Country:US
Practice Address - Phone:781-756-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9722980Medicaid
MAM21124Medicare ID - Type Unspecified