Provider Demographics
NPI:1740687441
Name:DOCTORS CHOICE PROFESSIONAL LABORATORY & DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:DOCTORS CHOICE PROFESSIONAL LABORATORY & DIAGNOSTIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BODLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-852-2723
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06793-0272
Mailing Address - Country:US
Mailing Address - Phone:888-852-2723
Mailing Address - Fax:888-952-2723
Practice Address - Street 1:1 TITUS RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1516
Practice Address - Country:US
Practice Address - Phone:888-852-2723
Practice Address - Fax:888-952-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty