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General NPI Number Information
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NPI Number | 1154628188
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Entity Type | Organization
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Legal Business Name | CHESTER RIVER HEALTH LAB - CENTREVILLE
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 100 BROWN ST
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1435
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Country | US
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Telephone | 410-778-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 202 COURSEVALL DR SUITE 107
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City | CENTREVILLE
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State | MD
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Zip | 21617-2804
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Country | US
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Telephone | 410-778-3300
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PATIENT FINANCIAL SERVICE
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Name | MRS. CARDELLA TRYTHALL FORRESTER
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Credential | CPAM, CHAM
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Telephone | 410-810-5192
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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 | 21D022037
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License Number State | MD
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