Provider Demographics
NPI:1275780967
Name:QUEST DIAGNOSTICS OF PENNSYLVANIA INC.
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS OF PENNSYLVANIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-454-6000
Mailing Address - Street 1:14275 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:774-843-3205
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1745 NILES CORTLAND ROAD
Practice Address - Street 2:STE. 5
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-0000
Practice Address - Country:US
Practice Address - Phone:330-393-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-25
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D1067584291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory