Provider Demographics
NPI:1295812360
Name:WESTERN MASSACHUSETTS PATHOLOGY SERVICES, PC
Entity type:Organization
Organization Name:WESTERN MASSACHUSETTS PATHOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KROCHMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-447-2569
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0781
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2097
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45390207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA751038OtherTUFTS HEALTH PLAN
MA9775102Medicaid
102749600OtherUS DEPT OF LABOR
MA0011307OtherNEIGHBORHOOD HEALTH PLAN
MA000000024512OtherBMC HEALTH NET
MAM16092OtherBC/BS
CT003124683Medicaid
VT1005020Medicaid
MA9775102Medicaid
CA3932Medicare ID - Type UnspecifiedRAIL ROAD