Provider Demographics
NPI:1922197631
Name:PATHOLOGY ASSOCIATES OF WINDHAM PC
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF WINDHAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-456-6729
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0955
Mailing Address - Country:US
Mailing Address - Phone:860-456-6729
Mailing Address - Fax:860-456-6934
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2041
Practice Address - Country:US
Practice Address - Phone:860-456-6729
Practice Address - Fax:860-456-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004090429Medicaid
CTC00553Medicare PIN
CG7727Medicare PIN