Provider Demographics
NPI:1083152698
Name:ADVANCE LABORATORIES LLC
Entity Type:Organization
Organization Name:ADVANCE LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADJEI
Authorized Official - Suffix:
Authorized Official - Credentials:MT (ASCP), BA, BS
Authorized Official - Phone:301-586-9288
Mailing Address - Street 1:19614 CLUB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3035
Mailing Address - Country:US
Mailing Address - Phone:301-586-9288
Mailing Address - Fax:
Practice Address - Street 1:19614 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-3035
Practice Address - Country:US
Practice Address - Phone:301-586-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory