Provider Demographics
NPI:1780797936
Name:CONNECTICUT PATHOLOGY LABORATORIES, INC.
Entity type:Organization
Organization Name:CONNECTICUT PATHOLOGY LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CT (ASCP)
Authorized Official - Phone:860-450-1823
Mailing Address - Street 1:1320 MAIN ST
Mailing Address - Street 2:STE. 24
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1940
Mailing Address - Country:US
Mailing Address - Phone:860-450-1823
Mailing Address - Fax:
Practice Address - Street 1:1320 MAIN ST
Practice Address - Street 2:STE. 24
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1940
Practice Address - Country:US
Practice Address - Phone:862-803-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCL0465291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004095122Medicaid