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General NPI Number Information
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NPI Number | 1295773380
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH MEDICAL LABS INC.
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 4228 AIKEN DR
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City | WARRENTON
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State | VA
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Zip | 20187-3931
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Country | US
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Telephone | 540-428-2909
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Fax | 540-428-2905
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Provider Business Mailing Address
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Address Line | 4228 AIKEN DR
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City | WARRENTON
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State | VA
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Zip | 20187-3931
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Country | US
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Telephone | 540-428-2909
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Fax | 540-428-2905
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL D PRATT
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Credential |
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Telephone | 540-428-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 49D0661031
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License Number State | VA
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