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General NPI Number Information
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NPI Number | 1518028521
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Entity Type | Organization
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Legal Business Name | BERKELEY FAMILY MEDICINA ASSOCIATES LAB
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 101 MARCLEY DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-2977
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Country | US
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Telephone | 304-263-8911
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Fax | 304-263-9098
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Provider Business Mailing Address
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Address Line | 101 MARCLEY DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-2977
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Country | US
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Telephone | 304-263-8911
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Fax | 304-263-9098
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUMMER D MOORE
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Credential |
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Telephone | 304-263-8911
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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 | 51D0234567
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License Number State | WV
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