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General NPI Number Information
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NPI Number | 1063866366
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Entity Type | Organization
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Legal Business Name | METRO LAB LLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 2207 4TH STREET NE
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City | WASHINGTON
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State | DC
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Zip | 20002
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Country | US
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Telephone | 202-629-4107
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Fax |
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Provider Business Mailing Address
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Address Line | 3422 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-702-5717
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KASSAHUN TEFERA
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Credential |
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Telephone | 202-413-1092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 09D1087026
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License Number State | DC
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