Healthcare Provider Details

I. General information

NPI: 1144989070
Provider Name (Legal Business Name): VITAL SOLUTIONS LAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 202-579-9007
  • Fax:
Mailing address:
  • Phone: 202-579-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE NDIONGUE
Title or Position: OWNER
Credential: BSN, RN, MHA
Phone: 202-579-9007