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General NPI Number Information
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NPI Number | 1417231226
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Entity Type | Organization
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Legal Business Name | SUBURBAN MEDICAL LABORATORY, INC
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 6800 VIRGINIA MANOR RD
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City | BELTSVILLE
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State | MD
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Zip | 20705-4200
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Country | US
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Telephone | 216-409-7394
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 VIRGINIA MANOR RD
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City | BELTSVILLE
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State | MD
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Zip | 20705-4200
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Country | US
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Telephone | 216-409-7394
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, BILLING
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Name | MR. DONALD HOSKINS
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Credential |
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Telephone | 51237527300
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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 | 36D0339673
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License Number State | OH
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