Organization
CONNECTICUT PATHOLOGY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN LEVINE MD (CHIEF)
(860) 344-6174
Entity
Organization
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 344-6174
(860) 344-6062
Mailing address
PO BOX 1590, NEW HAVEN, CT 06506-1590
(203) 397-8000
(203) 389-1540
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
016547
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039758
AETNA/USHC GRP#
CT
01
—
0077315
CIGNA GRP#
CT
05
—
4053021
—
CT
01
—
4832
CONNECTICARE GROUP#
CT
01
—
500HBL066CT01
BCBS GROUP#
CT
Enumeration date
07/02/2006
Last updated
08/17/2018
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