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General NPI Number Information
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NPI Number | 1962659656
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Entity Type | Organization
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Legal Business Name | QUEST DIAGNOSTICS OF PENNSYLVANIA INC
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 835 SOUTHWESTERN RUN LABORATORY
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City | BOARDMAN
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State | OH
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Zip | 44514-0000
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Country | US
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Telephone | 330-318-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S COLLEGEVILLE RD
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2998
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Country | US
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Telephone | 666-978-3788
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHARLES ALBERT BOWLES
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Credential |
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Telephone | 610-454-6000
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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 | 36D1067585
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License Number State | OH
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