Organization
DERMATOPATHOLOGY LABORATORY OF NEW ENGLAND PC
Active
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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