Healthcare Provider Details

I. General information

NPI: 1356651376
Provider Name (Legal Business Name): SUBURBAN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR SUITE 150
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

PO BOX 79216
BALTIMORE MD
21279-0216
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-6002
  • Fax: 301-230-1927
Mailing address:
  • Phone: 301-896-6002
  • Fax: 301-230-1927

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: MR. BRIAN A GRAGNOLATI
Title or Position: PRESIDENT
Credential:
Phone: 301-896-2574