Provider Demographics
NPI:1306867981
Name:BIOMEDICAL LABORATORIES
Entity Type:Organization
Organization Name:BIOMEDICAL LABORATORIES
Other - Org Name:BIOMEDICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APPU
Authorized Official - Middle Name:K
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-783-0600
Mailing Address - Street 1:480 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2655
Mailing Address - Country:US
Mailing Address - Phone:617-783-0600
Mailing Address - Fax:617-783-0602
Practice Address - Street 1:480 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2655
Practice Address - Country:US
Practice Address - Phone:617-783-0600
Practice Address - Fax:617-783-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2427291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD701421OtherTUFTS HEALTH PLAN
MA9724627OtherCIGNA
MA11470212OtherCAQH
MA0802344Medicaid
MA228400OtherBLUE CROSS BLUE SHIELD
MA0008779OtherCHILDREN'S MEDICAL
MA800345OtherHARVARD PILGRIM
MA=========OtherPHCS
MA9724627OtherCIGNA
MA0802344Medicaid