Organization
PIEDMONT JOINT VENTURE LABORATORY, INC.
Active
Other names
Piedmont Medical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DOUGHERTY (PRESIDENT)
(703) 222-2313
Entity
Organization
Contact information
Practice address
333 W CORK ST, SUITE 215, WINCHESTER, VA 22601-3870
(540) 536-5500
(540) 665-4162
Mailing address
333 W CORK ST, SUITE 215, WINCHESTER, VA 22601-3871
(540) 536-5500
(540) 665-4162
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037433000
—
VT
01
—
234867
MAMSI PROVIDER NUMBER
VA
01
—
383117
ANTHEM PROVIDER NUMBER
VA
01
—
77885
SENTARA PROVIDER NUMBER
VA
05
—
E4981219
—
VA
Enumeration date
06/13/2006
Last updated
10/15/2009
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