MEDICARE: DORSEY HALL MEDICAL LABORATORY, LLC

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	983	MD

General Provider Information

NPI Number	:	1376503243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSEY HALL MEDICAL LABORATORY, LLC

Provider Business Mailing Address
First Line	:	8186 LARK BROWN RD
Second Line	:	SUITE 103
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6420
Country	:	US
Telephone Number	:	410-799-8100
Fax Number	:	410-799-0069

Provider Business Practice Location Address
First Line	:	8186 LARK BROWN RD
Second Line	:	SUITE 103
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6420
Country	:	US
Telephone Number	:	410-799-8100
Fax Number	:	410-799-0069

Authorized Official
Title or Position	:	OWNER
Name	:	JANET F SUAREZ
Credential	:
Telephone Number	:	410-799-8100

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/22/2020

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