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Organization

CROWN PATHOLOGY P A

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN TEWKSBURY (OWNER)
(207) 768-4013
Entity
Organization

Contact information

Practice address
140 ACADEMY ST, PRESQUE ISLE, ME 04769-3102
(207) 768-4209
(207) 768-4013
Mailing address
27 STATE PARK RD, PRESQUE ISLE, ME 04769-5247

Taxonomy

Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
012546
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1962423814
ME
Enumeration date
10/30/2014
Last updated
10/30/2014
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