Provider Demographics
NPI:1073088449
Name:ELC LAB SERVICES LLC
Entity Type:Organization
Organization Name:ELC LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-548-3733
Mailing Address - Street 1:2528 MOUNTAIN RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7204
Mailing Address - Country:US
Mailing Address - Phone:443-548-3733
Mailing Address - Fax:
Practice Address - Street 1:2528 MOUNTAIN RD STE 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7204
Practice Address - Country:US
Practice Address - Phone:443-548-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory