NPI 1538256805

Pediatric Associate

Organisation Clinical Medical Laboratory Bridgeport, WV

Practice location

Address: 11 Chenoweth Dr Suite a, Bridgeport, WV 26330-1675
Phone: (304) 842-5777
Fax: (304) 842-3318

Authorised official

Name: Manzar Momen
Title: Office Manager
Phone: (304) 842-5777

Registered specialties

Clinical Medical Laboratory Primary

Laboratories Taxonomy 291U00000X Licence WV11941 (WV)

Other Clinical Medical Laboratory providers in West Virginia →

Registry record

NPI: 1538256805
Entity type: Organization
NPI issued: 6 Oct 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.