MEDICARE: MAGNUS DIAGNOSTICS LABORATORIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	2551	MD

General Provider Information

NPI Number	:	1073063939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNUS DIAGNOSTICS LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	8120 FENTON ST STE 301A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4796
Country	:	US
Telephone Number	:	301-588-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 FENTON ST STE 301A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4796
Country	:	US
Telephone Number	:	301-588-1025
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CHRISTINE MCNAIR
Credential	:
Telephone Number	:	301-588-1025

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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