Provider Demographics
NPI:1184924102
Name:CLINICAL PATHOLOGY DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:CLINICAL PATHOLOGY DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-647-6487
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06505-1406
Mailing Address - Country:US
Mailing Address - Phone:203-647-6487
Mailing Address - Fax:203-647-6487
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6487
Practice Address - Fax:860-647-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00061361649OtherUS HEALTHCARE
CT01026848OtherCIGNA
CT0008172967OtherAETNA
CT01023300OtherCIGNA
CT01025761OtherCIGNA
CT2927760OtherCIGNA
CT061361649OtherCIGNA
CT1104296OtherUNITED HEALTHCARE
CT761649-01OtherCONNECTICARE