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General NPI Number Information
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NPI Number | 1265685440
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Entity Type | Organization
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Legal Business Name | CCC DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 3918 VERO ROAD SUITE B
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City | BALTIMORE
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State | MD
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Zip | 21227-1522
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Country | US
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Telephone | 410-633-3570
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 7467
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City | BALTIMORE
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State | MD
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Zip | 21227-7467
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Country | US
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Telephone | 410-633-3570
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND MANAGING DIRECTOR
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Name | DR. PAUL O.P. TS'O
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Credential | PH.D.
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Telephone | 410-633-3570
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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 | 1274
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License Number State | MD
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