Provider Demographics
NPI:1962423814
Name:CROWN PATHOLOGY, PA
Entity type:Organization
Organization Name:CROWN PATHOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-7529
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-1820
Mailing Address - Country:US
Mailing Address - Phone:207-764-7529
Mailing Address - Fax:207-764-6504
Practice Address - Street 1:140 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-768-4209
Practice Address - Fax:207-768-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012546207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME9482121OtherCIGNA GROUP #
ME003962OtherANTHEM
ME220016505OtherRAILROAD MEDICARE GROUP #
ME123680000Medicaid
ME220016505OtherRAILROAD MEDICARE GROUP #