Provider Demographics
NPI:1841256195
Name:NEWTON WELLESLEY PATHOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:NEWTON WELLESLEY PATHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-243-6140
Mailing Address - Street 1:PO BOX 490940
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0016
Mailing Address - Country:US
Mailing Address - Phone:770-237-4500
Mailing Address - Fax:770-237-4539
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6140
Practice Address - Fax:617-243-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9735861Medicaid
MAM12065Medicare PIN