Healthcare Provider Details

I. General information

NPI: 1538078605
Provider Name (Legal Business Name): CHESAPEAKE MOBILE LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N POINT BLVD STE 331
BALTIMORE MD
21224-3472
US

IV. Provider business mailing address

1105 N POINT BLVD STE 331
BALTIMORE MD
21224-3472
US

V. Phone/Fax

Practice location:
  • Phone: 410-517-7060
  • Fax: 443-407-2942
Mailing address:
  • Phone: 410-517-7060
  • Fax: 443-407-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BLACKSTON
Title or Position: DIRECTOR
Credential: CRNP
Phone: 410-517-7060