=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033360466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO LAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2008
-----------------------------------------------------
Last Update Date | 09/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 VERMONT AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20001-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-413-1092
-----------------------------------------------------
Fax | 202-939-0526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2017 VERMONT AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-413-1092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. KASSAHUN TEFERA
-----------------------------------------------------
Credential | ASCP
-----------------------------------------------------
Telephone | 202-413-1092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 09D1087026
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------