Healthcare Provider Details

I. General information

NPI: 1821043928
Provider Name (Legal Business Name): FOUAD N BOCTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER MEDICAL LABORATORY 100 N. ACADEMY AVE
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

GEISINGER MEDICAL LABORATORY 100 N. ACADEMY AVE
DANVILLE PA
17822-0001
US

V. Phone/Fax

Practice location:
  • Phone: 845-300-3901
  • Fax:
Mailing address:
  • Phone: 845-300-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number26036
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number430098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: