Healthcare Provider Details

I. General information

NPI: 1740507409
Provider Name (Legal Business Name): SUBURBAN HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

PO BOX 824307
PHILADELPHIA PA
19182-4307
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-6002
  • Fax:
Mailing address:
  • Phone: 301-896-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number15332
License Number StateMD

VIII. Authorized Official

Name: MS. JACQUELINE SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 301-896-2574