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General NPI Number Information
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NPI Number | 1952465288
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Entity Type | Organization
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Legal Business Name | BOSTWICK LABORATORIES, INC.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 4851 LAKE BROOK DR
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City | GLEN ALLEN
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State | VA
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Zip | 23060-9233
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Country | US
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Telephone | 804-967-9225
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Fax | 804-239-1954
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Provider Business Mailing Address
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Address Line | PO BOX 403751
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City | ATLANTA
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State | GA
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Zip | 30384-3751
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Country | US
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Telephone | 804-967-9225
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Fax | 804-239-1954
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Authorized Official
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Title or Position | CEO, PRESIDENT, CHIEF MED. OFFICER
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Name | DR. DAVID GRANGER BOSTWICK
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Credential | MD
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Telephone | 804-967-9225
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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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