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General NPI Number Information
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NPI Number | 1881996775
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Entity Type | Organization
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Legal Business Name | MACROLAB LLC
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Dates
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Enumeration Date | 11/26/2010
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Last Update Date | 11/26/2010
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Provider Practice Location Address
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Address Line | 1310 INDUSTRIAL HWY SUITE 203
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4030
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Country | US
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Telephone | 267-978-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 INDUSTRIAL HWY SUITE 203
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4030
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Country | US
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Telephone | 267-978-1993
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GEORGE SEDRAKYAN
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Credential | MD
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Telephone | 267-978-1993
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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 | 39D2016029
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License Number State | PA
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