Provider Demographics
NPI:1063580264
Name:PATHOLOGISTS OF SAINT ANNES PC
Entity type:Organization
Organization Name:PATHOLOGISTS OF SAINT ANNES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:W
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-674-5600
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-0852
Mailing Address - Country:US
Mailing Address - Phone:508-674-5600
Mailing Address - Fax:508-235-5329
Practice Address - Street 1:795 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1733
Practice Address - Country:US
Practice Address - Phone:508-674-5600
Practice Address - Fax:508-235-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISA01978Medicaid
MA9736425Medicaid
RISA01978Medicaid