Provider Demographics
NPI:1164645313
Name:MEDSTAR RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:MEDSTAR RESEARCH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-209-6855
Mailing Address - Street 1:6525 BELCREST RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2003
Mailing Address - Country:US
Mailing Address - Phone:301-209-6855
Mailing Address - Fax:301-209-6862
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-209-6855
Practice Address - Fax:301-209-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC=========OtherTAX IDENTIFICATION NUMBER