Organization
MAIN LINE HEALTH LABORATORIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BUONGIORNO (CHIEF FINANCIAL OFFICER)
(484) 337-8480
Entity
Organization
Contact information
Practice address
240 N RADNOR CHESTER RD, SUITE 360, RADNOR, PA 19087-5170
(610) 229-4100
Mailing address
950 E HAVERFORD RD, SUITE 110, BRYN MAWR, PA 19010-3850
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
000199
PA
291U00000X
Clinical Medical Laboratory
Primary
000213
PA
291U00000X
Clinical Medical Laboratory
000242
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001575827-01
AMERICHOICE
—
05
—
0015758270003
—
PA
05
—
0015758270004
—
PA
05
—
0015758270006
—
PA
01
—
310260
BLUE SHIED
—
01
—
6343
PERSONAL CHOICE
—
01
—
690006671
RAILROAD MEDICARE
—
Enumeration date
09/20/2006
Last updated
06/02/2011
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