Healthcare Provider Details

I. General information

NPI: 1689923989
Provider Name (Legal Business Name): LABORATORY RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 THOMAS JOHNSON DR STE 205
FREDERICK MD
21702-4403
US

IV. Provider business mailing address

217 E CHURCHVILLE RD
BEL AIR MD
21014-3825
US

V. Phone/Fax

Practice location:
  • Phone: 240-815-5449
  • Fax:
Mailing address:
  • Phone: 410-698-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: AURA IONITA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-522-2727