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General NPI Number Information
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NPI Number | 1942321203
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Entity Type | Organization
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Legal Business Name | LABORATORY FOR CLINICAL MEDICINE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 CORPORATE PL SUITE #7
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City | PEABODY
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State | MA
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Zip | 01960-3840
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Country | US
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Telephone | 978-535-3317
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Fax | 978-535-1934
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Provider Business Mailing Address
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Address Line | 200 CORPORATE PL SUITE #7
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City | PEABODY
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State | MA
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Zip | 01960-3840
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Country | US
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Telephone | 978-535-3317
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Fax | 978-535-1934
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. PETER MICHAEL MCNICHOLAS
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Credential |
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Telephone | 978-535-3317
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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 | 2404
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License Number State | MA
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