MEDICARE: AMG LAB AND DIAGNOSTICS

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

General Provider Information

NPI Number	:	1154171080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMG LAB AND DIAGNOSTICS

Provider Business Mailing Address
First Line	:	9908 OXON CREEK CT
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-3688
Country	:	US
Telephone Number	:	443-707-7205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 YORK RD
Second Line	:	SUITE 800-LT2
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	443-707-7205
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHELLE MADU
Credential	:
Telephone Number	:	443-707-7205

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	07/24/2025

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