Provider Demographics
NPI:1720126972
Name:MAHASAEN, CHOOMPOL (M,D)
Entity Type:Individual
Prefix:
First Name:CHOOMPOL
Middle Name:
Last Name:MAHASAEN
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5445
Mailing Address - Country:US
Mailing Address - Phone:508-655-0396
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-5445
Practice Address - Country:US
Practice Address - Phone:508-655-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36439207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology