Basic Information
| Provider Information | |||||||||
| NPI: | 1427037134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LABORATORY MEDICINE ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MERIDIAN BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103724957 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | LEHIGHTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182351138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662972320 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 07/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | FEINBERG | ||||||||
| AuthorizedOfficialFirstName: | KALMEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5703872119 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0009648940006 | 05 | PA | MEDICAID |