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General NPI Number Information
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NPI Number | 1871355446
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Entity Type | Organization
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Legal Business Name | AG LAB SERVICE
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 137 LOG CANOE CIR
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2127
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Country | US
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Telephone | 443-249-3405
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Fax | 443-249-3123
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Provider Business Mailing Address
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Address Line | 137 LOG CANOE CIR
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2127
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Country | US
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Telephone | 443-249-3405
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Fax | 443-249-3123
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Authorized Official
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Title or Position | OWNER
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Name | ATEEYA GRAY
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Credential |
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Telephone | 443-249-3405
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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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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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