Healthcare Provider Details

I. General information

NPI: 1760004261
Provider Name (Legal Business Name): PHLEBOTOMY MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 PULASKI HWY
BALTIMORE MD
21224-1534
US

IV. Provider business mailing address

7220 DORCHESTER WOODS LN
HANOVER MD
21076-2038
US

V. Phone/Fax

Practice location:
  • Phone: 240-229-7043
  • Fax:
Mailing address:
  • Phone: 800-944-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEISHA DAVIS
Title or Position: CEO
Credential:
Phone: 240-229-7043