MEDICARE: WESTERN LABORATORIES

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

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	:	1871555979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN LABORATORIES

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	27200 CALAROGA AVE
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94545-4339
Country	:	US
Telephone Number	:	510-264-4035
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ELIZABETH TREYNOR
Credential	:	MD
Telephone Number	:	510-264-4035

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/12/2017

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Directions to “WESTERN LABORATORIES ” Practice Location

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