Healthcare Provider Details

I. General information

NPI: 1225035132
Provider Name (Legal Business Name): AFFILIATED LABORATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST
BANGOR ME
04401-6630
US

IV. Provider business mailing address

417 STATE ST
BANGOR ME
04401-6630
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6900
  • Fax:
Mailing address:
  • Phone: 207-973-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateME

VIII. Authorized Official

Name: MS. KAREN POMEROY
Title or Position: VICE PRESIDENT
Credential: MT (ASCP)
Phone: 207-973-6905