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General NPI Number Information
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NPI Number | 1821728031
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Entity Type | Organization
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Legal Business Name | IMPACT DIAGNOSTIC LAB & HEALTH SERVICES
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 7375 EXECUTIVE PL STE 222
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City | LANHAM
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State | MD
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Zip | 20706-2278
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Country | US
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Telephone | 215-252-6748
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Fax |
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Provider Business Mailing Address
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Address Line | 8551 RITCHBORO RD
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-2646
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Country | US
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Telephone | 215-252-6748
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | ELIZABETH A AKINFIRESOYE
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Credential |
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Telephone | 215-252-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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