Organization
DERMATOPATHOLOGY LABORATORY OF NEW ENGLAND PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP EDWIN SHAPIRO MD (PRESIDENT)
(208) 630-2666
Entity
Organization
Contact information
Practice address
140 GREEN RD, MERIDEN, CT 06450-6612
(203) 630-2666
(203) 630-2909
Mailing address
140 GREEN RD, MERIDEN, CT 06450-6612
(203) 630-2666
(203) 630-2909
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
029159
CT
291U00000X
Clinical Medical Laboratory
Primary
CL0562
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236081
—
CT
01
—
070CL0562CT01
ANTHEM BCBS
—
Enumeration date
08/04/2006
Last updated
02/25/2013
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