MEDICARE: SEPA LAB - BRISTOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician

General Provider Information

NPI Number	:	1063055200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEPA LAB - BRISTOL

Provider Business Mailing Address
First Line	:	721 DRESHER RD STE 2500
Second Line	:
City	:	HORSHAM
State	:	PA
Zip	:	19044-2218
Country	:	US
Telephone Number	:	855-235-7246
Fax Number	:	215-702-7075

Provider Business Practice Location Address
First Line	:	200 RITTENHOUSE CIRCLE
Second Line	:	STE 1A EAST
City	:	BRISTOL
State	:	PA
Zip	:	19007-1619
Country	:	US
Telephone Number	:	855-235-7246
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICK C FALL
Credential	:	DO
Telephone Number	:	855-235-7246

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	11/27/2023

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