MEDICARE: SENECA MEDICAL LAB, INC.

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	291U00000X	Clinical Medical Laboratory	029257	PA

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	:	1548215304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENECA MEDICAL LAB, INC.

Provider Business Mailing Address
First Line	:	401 COMMERCE DR
Second Line	:	SUITE 200
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2714
Country	:	US
Telephone Number	:	215-643-9960
Fax Number	:	215-643-9963

Provider Business Practice Location Address
First Line	:	401 COMMERCE DR
Second Line	:	SUITE 200
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2714
Country	:	US
Telephone Number	:	215-643-9960
Fax Number	:	215-643-9963

Authorized Official
Title or Position	:	CONTROLLER
Name	:	JOAN LESLIE HOGAN
Credential	:
Telephone Number	:	215-643-9960

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/22/2020

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