Healthcare Provider Details

I. General information

NPI: 1568302990
Provider Name (Legal Business Name): VEGAS LAHAIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CHARLES ST
BALTIMORE MD
21201-3740
US

IV. Provider business mailing address

295 LIMESTONE CIR
CONYERS GA
30013-5244
US

V. Phone/Fax

Practice location:
  • Phone: 443-800-0802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: