Basic Information
| Provider Information | |||||||||
| NPI: | 1518345735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS INCORPORATED MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 S COLLEGEVILLE RD | ||||||||
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| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194262998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104546146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8505 ARLINGTON BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037762593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | CONDE | ||||||||
| AuthorizedOfficialFirstName: | WILSON | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9735202911 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.