Connecticut Pathology Laboratories, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CL0465 Issued in CT

Legal business name

CONNECTICUT PATHOLOGY LABORATORIES, INC.

Practice address

1320 Main St
Ste. 24
Willimantic, CT 06226-1940

Phone

(862) 803-1079

NPI assigned

Aug 15, 2006

Last updated

Apr 21, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Christine R Coble, M.S., CT (ASCP)

Title

Laboratory Manager

Phone

(860) 450-1823

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1780797936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MAIN ST",
            "address_2": "STE. 24",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261940",
            "telephone_number": "860-450-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MAIN ST",
            "address_2": "STE. 24",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261940",
            "telephone_number": "862-803-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT PATHOLOGY LABORATORIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "COBLE",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "LABORATORY MANAGER",
        "authorized_official_telephone_number": "860-450-1823",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., CT (ASCP)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CT",
            "license": "CL0465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004095122",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Clinical Medical Laboratory in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.