MEDICARE: QUEST DIAGNOSTICS INCORPORATED MA

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1659710424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS INCORPORATED MA

Provider Business Mailing Address
First Line	:	1001 ADAMS AVE
Second Line	:	MRGOV 2ND FLOOR
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2429
Country	:	US
Telephone Number	:	484-676-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 BOSTON POST RD W
Second Line	:	SUITE A
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-0000
Country	:	US
Telephone Number	:	617-520-7406
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	J PABLO LAKE
Credential	:
Telephone Number	:	484-676-7000

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	02/11/2014

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