Provider Demographics
NPI:1619058005
Name:CRANSTON/DOTTIN BIOMEDICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:CRANSTON/DOTTIN BIOMEDICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CRANSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:340-774-6256
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00804-1252
Mailing Address - Country:US
Mailing Address - Phone:340-774-6256
Mailing Address - Fax:340-774-1901
Practice Address - Street 1:3004 CONTANT
Practice Address - Street 2:MEDICAL ARTS COMPLEX #3
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-6256
Practice Address - Fax:340-774-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI4419291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30903OtherPIN