Provider Demographics
NPI:1548885676
Name:FRONTAGE LABORATORIES, INC.
Entity type:Organization
Organization Name:FRONTAGE LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, PATHOLOGY & CLINICAL INFORMATIC
Authorized Official - Prefix:
Authorized Official - First Name:BUER
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-645-2254
Mailing Address - Street 1:700 PENNSYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1129
Mailing Address - Country:US
Mailing Address - Phone:424-645-2254
Mailing Address - Fax:
Practice Address - Street 1:700 PENNSYLVANIA DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1129
Practice Address - Country:US
Practice Address - Phone:424-645-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory