MEDICARE: LABORATORY CORPORATION OF AMERICA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21D2096092	OTHER		CLIA

General Provider Information

NPI Number	:	1457730129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORY CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27216-2240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 BUCKEYSTOWN PIKE
Second Line	:	SUITE 186
City	:	FREDERICK
State	:	MD
Zip	:	21704-8336
Country	:	US
Telephone Number	:	703-707-2262
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY WILLIAMS
Credential	:
Telephone Number	:	800-222-7566

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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Directions to “LABORATORY CORPORATION OF AMERICA ” Practice Location

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