Healthcare Provider Details

I. General information

NPI: 1376312272
Provider Name (Legal Business Name): CAROLINA DIAGNOSTIC LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 PYLON DR
RALEIGH NC
27606-1414
US

IV. Provider business mailing address

517 PYLON DR
RALEIGH NC
27606-1414
US

V. Phone/Fax

Practice location:
  • Phone: 410-868-8343
  • Fax:
Mailing address:
  • Phone: 410-868-8343
  • 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: MR. MANOJ TYAGI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 410-868-8343