Healthcare Provider Details

I. General information

NPI: 1841916111
Provider Name (Legal Business Name): RE-SET LAB & DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK RD STE 800
LUTHERVILLE MD
21093-6011
US

IV. Provider business mailing address

44 SPRINGTIME WAY
BALTIMORE MD
21234-8704
US

V. Phone/Fax

Practice location:
  • Phone: 410-746-5397
  • Fax:
Mailing address:
  • Phone: 410-816-4401
  • Fax:

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: SIARA BAZEMORE
Title or Position: CEO
Credential:
Phone: 410-816-4401