Healthcare Provider Details

I. General information

NPI: 1942396742
Provider Name (Legal Business Name): EASTERN PANHANDLE PEDIATRICS, PLLC LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PROFESSIONAL CT SUITE C
MARTINSBURG WV
25401-8758
US

IV. Provider business mailing address

2000 PROFESSIONAL CT SUITE C
MARTINSBURG WV
25401-8758
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-8853
  • Fax: 304-263-6178
Mailing address:
  • Phone: 304-263-8853
  • Fax: 304-263-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number09975
License Number StateWV

VIII. Authorized Official

Name: DR. EDWARD FIKE ARNETT
Title or Position: PARTNER
Credential: M.D.
Phone: 304-263-8853