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General NPI Number Information
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NPI Number | 1578689865
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Entity Type | Organization
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Legal Business Name | MAIN LINE CLINICAL LABORATORIES
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 255 W LANCASTER AVE
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City | PAOLI
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State | PA
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Zip | 19301-1763
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Country | US
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Telephone | 610-229-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 950 E HAVERFORD RD SUITE 110
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City | BRYN MAWR
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State | PA
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Zip | 19010-3850
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Country | US
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Telephone | 610-526-8480
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MICHAEL J BUONGIORNO
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Credential |
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Telephone | 610-526-8480
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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 | 000199
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License Number State | PA
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