Healthcare Provider Details

I. General information

NPI: 1346636461
Provider Name (Legal Business Name): BURLINGTON LABS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 MAIN ST SUITE 226
BURLINGTON VT
05401-8309
US

IV. Provider business mailing address

199 MAIN ST SUITE 226
BURLINGTON VT
05401-8309
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-4105
  • Fax:
Mailing address:
  • Phone: 802-863-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STUART M. WILES
Title or Position: CFO
Credential:
Phone: 802-863-4105