Provider Demographics
NPI:1043394943
Name:TERZETTO DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:TERZETTO DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-238-7039
Mailing Address - Street 1:2812 CARROLLTON PIKE
Mailing Address - Street 2:P.O. BOX 122
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3662
Mailing Address - Country:US
Mailing Address - Phone:276-236-3002
Mailing Address - Fax:276-236-8255
Practice Address - Street 1:2812 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3662
Practice Address - Country:US
Practice Address - Phone:276-728-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory