Healthcare Provider Details

I. General information

NPI: 1073088449
Provider Name (Legal Business Name): ELC LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 MOUNTAIN RD STE 204
PASADENA MD
21122-7204
US

IV. Provider business mailing address

2528 MOUNTAIN RD STE 204
PASADENA MD
21122-7204
US

V. Phone/Fax

Practice location:
  • Phone: 443-548-3733
  • Fax:
Mailing address:
  • Phone: 443-548-3733
  • 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: MS. SARA BURDEN
Title or Position: OWNER
Credential:
Phone: 443-548-3733