Healthcare Provider Details

I. General information

NPI: 1942374780
Provider Name (Legal Business Name): MEDICAL DRUG TESTING LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 PLYMOUTH AVE
FALL RIVER MA
02721
US

IV. Provider business mailing address

427 PLYMOUTH AVE
FALL RIVER MA
02721
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-0010
  • Fax: 508-672-4679
Mailing address:
  • Phone: 508-679-0010
  • Fax: 508-672-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2583
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number2583
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NAUKA PATEL
Title or Position: ADM
Credential:
Phone: 508-679-0010