Organization
LANDMARK MEDICAL CENTER
Active
Other names
Landmark MC Pathology Dept.
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MACINTOSH (SVP/CFO)
(401) 769-4100
Entity
Organization
Contact information
Practice address
115 CASS AVE, WOONSOCKET, RI 02895-4705
(401) 769-4100
(401) 769-1744
Mailing address
196 CASS AVE, WOONSOCKET, RI 02895-4712
(401) 769-4100
(401) 765-6024
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
00117
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9006490
—
RI
01
—
903288
TUFTS HEALTH PLAN (OP)
MA
01
—
903289
TUFTS HEALTH PLAN (IP)
MD
Enumeration date
12/29/2005
Last updated
08/22/2020
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