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General NPI Number Information
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NPI Number | 1992160436
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE TOXICOLOGY RESOURCES, LLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 8415 PROGRESS DR SUITE V
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City | FREDERICK
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State | MD
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Zip | 21701-4760
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Country | US
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Telephone | 610-637-4293
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 PROGRESS DR SUITE V
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City | FREDERICK
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State | MD
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Zip | 21701-4760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | LISA JACKSON
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Credential |
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Telephone | 267-566-2075
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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 | 2102105193
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License Number State | MD
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