Healthcare Provider Details

I. General information

NPI: 1528169695
Provider Name (Legal Business Name): PRINCETON PEDIATRICS LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 NEW HOPE RD
PRINCETON WV
24740-2135
US

IV. Provider business mailing address

216 NEW HOPE RD
PRINCETON WV
24740-2135
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-2355
  • Fax: 304-487-0092
Mailing address:
  • Phone: 304-425-2355
  • Fax: 304-487-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number11298
License Number StateWV

VIII. Authorized Official

Name: ASMA SAFDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-425-2355