Provider Demographics
NPI:1053340125
Name:NORDGREN, ALLAN CURTIS (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:CURTIS
Last Name:NORDGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 OLD WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2514
Mailing Address - Country:US
Mailing Address - Phone:508-997-1515
Mailing Address - Fax:508-961-5303
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-997-1515
Practice Address - Fax:508-961-5303
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA034321207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074153Medicaid
MAJ10687Medicare ID - Type Unspecified
MA3074153Medicaid