Organization
MMHC
Active
Organization
MMHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT DUWORS PH. D. (LAB DIRECTOR)
(401) 624-7500
Entity
Organization
Contact information
Practice address
135 LAKE ST, SUITE 1, SAINT ALBANS, VT 05478-2249
(401) 624-7500
Mailing address
135 LAKE ST, SUITE 1, SAINT ALBANS, VT 05478-2249
(401) 624-7500
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
47D2086818
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47D2086818
CLIA
VT
Enumeration date
10/16/2015
Last updated
10/16/2015
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