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NPI 1588934947

NPI 1588934947 : QUEST DIAGNOSTICS MASSACHUSETTS LLC : PROVINCETOWN, MA

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General NPI Number Information
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    NPI Number           |    1588934947
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    Entity Type          |    Organization 
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    Legal Business Name  |    QUEST DIAGNOSTICS MASSACHUSETTS LLC 
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Dates
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    Enumeration Date     |    01/03/2012
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    Last Update Date     |    05/10/2013
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Provider Practice Location Address
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    Address Line         |    49 HARRY KEMP WAY ROOM 2 
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    City                 |    PROVINCETOWN
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    State                |    MA
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    Zip                  |    02657-1618
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    Country              |    US
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    Telephone            |    508-487-2062
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1001 ADAMS AVE MRGOV 2ND FLOOR
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    City                 |    NORRISTOWN
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    State                |    PA
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    Zip                  |    19403-2429
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    Country              |    US
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    Telephone            |    484-676-7000
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    Fax                  |    484-676-5309
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Authorized Official
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    Title or Position    |    VP
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    Name                 |     GERALD SCOTT CARTIER 
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    Credential           |    
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    Telephone            |    484-676-7000
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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       |    
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    License Number State |    
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