MEDICARE: DIAGNOSTIC LABORATORY MEDICINE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	2373	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25143	OTHER	MA	FALLON
2	35-00071	OTHER	TX	UNITED HEALTHCARE
3	800856	OTHER	MA	HARVARD PILGRIM
4	34-00008	OTHER	TX	UNITED HEALTHCARE EVERCAR
5	22-8019	OTHER	MA	BLUE CROSS
6	802319	OTHER	MA	TUFTS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184620775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC LABORATORY MEDICINE, INC

Provider Business Mailing Address
First Line	:	14 CROSBY DRIVE
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1451
Country	:	US
Telephone Number	:	800-582-6248
Fax Number	:	781-275-9689

Provider Business Practice Location Address
First Line	:	14 CROSBY DR
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1451
Country	:	US
Telephone Number	:	800-582-6248
Fax Number	:	781-275-9689

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	DR. JOSEPH MUSTO
Credential	:	PHD
Telephone Number	:	800-582-6248

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/12/2007

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