Provider Demographics
NPI:1124141239
Name:HOPE PEDIATRICS LAB
Entity type:Organization
Organization Name:HOPE PEDIATRICS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-677-3717
Mailing Address - Street 1:3512 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2946
Mailing Address - Country:US
Mailing Address - Phone:814-677-3717
Mailing Address - Fax:814-677-8914
Practice Address - Street 1:3512 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2946
Practice Address - Country:US
Practice Address - Phone:814-677-3717
Practice Address - Fax:814-677-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019684030001Medicaid