MEDICARE: PRINCETON PEDIATRICS LAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	11298	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528169695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON PEDIATRICS LAB

Provider Business Mailing Address
First Line	:	216 NEW HOPE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-2135
Country	:	US
Telephone Number	:	304-425-2355
Fax Number	:	304-487-0092

Provider Business Practice Location Address
First Line	:	216 NEW HOPE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-2135
Country	:	US
Telephone Number	:	304-425-2355
Fax Number	:	304-487-0092

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASMA SAFDER
Credential	:	M.D.
Telephone Number	:	304-425-2355

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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