Provider Demographics
NPI:1063477123
Name:UNITED MEDICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:UNITED MEDICAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-356-4422
Mailing Address - Street 1:1980 GALLOWS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3913
Mailing Address - Country:US
Mailing Address - Phone:703-356-4422
Mailing Address - Fax:703-356-2460
Practice Address - Street 1:1980 GALLOWS RD
Practice Address - Street 2:STE 300
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-3913
Practice Address - Country:US
Practice Address - Phone:703-356-4422
Practice Address - Fax:703-356-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD417291U00000X
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004980743Medicaid
DC0312387 00Medicaid
VA275360OtherBC/BS, ANTHEM (RICHMOND)
DCK093-0001OtherBC/BS, CAREFIRST, FEP
VA275359OtherBC/BS, ANTHEM, FEP (RICHMOND)
MD469178400Medicaid
VA275359OtherBC/BS, ANTHEM, FEP (RICHMOND)