Basic Information
| Provider Information | |||||||||
| NPI: | 1336590413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS TB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 FOREST ST FL 2 | ||||||||
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| City: | MARLBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017523023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554787877 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 NORWOOD PARK S | ||||||||
| Address2: | |||||||||
| City: | NORWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020624681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812550770 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | BOWLES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6104544122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 5889 | MA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.