MEDICARE: LABWORK 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	939	MD

General Provider Information

NPI Number	:	1770669376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABWORK LLC

Provider Business Mailing Address
First Line	:	PO BOX 1701
Second Line	:	130 PENNSYLVANIA AVE
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-1701
Country	:	US
Telephone Number	:	301-722-7270
Fax Number	:	301-722-7274

Provider Business Practice Location Address
First Line	:	130 PENNSYLVANIA AVE
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-4236
Country	:	US
Telephone Number	:	301-722-7270
Fax Number	:	301-722-7274

Authorized Official
Title or Position	:	OWNER
Name	:	DR. F DANIEL JACKSON
Credential	:	M.D.
Telephone Number	:	301-759-3817

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/22/2020

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Directions to “LABWORK LLC ” Practice Location

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