Provider Demographics
NPI:1164420568
Name:CD LABORATORIES, INC.
Entity Type:Organization
Organization Name:CD LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, GLOBAL MARKET ACCESS
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-518-7069
Mailing Address - Street 1:810 GLENEAGLES CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2231
Mailing Address - Country:US
Mailing Address - Phone:410-296-1400
Mailing Address - Fax:410-296-0081
Practice Address - Street 1:810 GLENEAGLES CT STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2231
Practice Address - Country:US
Practice Address - Phone:410-296-1400
Practice Address - Fax:410-296-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD204291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118869Medicaid
DC021732500Medicaid
IN201288030AMedicaid
AZ102738Medicaid
CT008058044Medicaid
NC00534551Medicaid
MDW212OtherMEDICARE PTAN