MEDICARE: L2 DIAGNOSTICS, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07DO943606	OTHER	CT	CLIA
2	CU5316	OTHER	CT	HEALTHNET
3	709946	OTHER	CT	CT CARE
4	A914266	OTHER	CT	OXFORD

General Provider Information

NPI Number	:	1598827636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L2 DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 208031
Second Line	:	300 CEDAR ST. TAC ROOM S-525
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8031
Country	:	US
Telephone Number	:	203-737-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CEDAR ST. TAC ROOM S-525
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8031
Country	:	US
Telephone Number	:	203-737-1952
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE PROFESSOR OF MEDICINE
Name	:	MARK J MAMULA
Credential	:	PH.D.
Telephone Number	:	203-785-2840

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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Directions to “L2 DIAGNOSTICS, LLC ” Practice Location

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