Provider Demographics
NPI:1346418977
Name:DMLA CORPORATION
Entity Type:Organization
Organization Name:DMLA CORPORATION
Other - Org Name:DML MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-343-3326
Mailing Address - Street 1:387 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2005
Mailing Address - Country:US
Mailing Address - Phone:570-343-3326
Mailing Address - Fax:570-969-4210
Practice Address - Street 1:387 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2005
Practice Address - Country:US
Practice Address - Phone:570-343-3326
Practice Address - Fax:570-969-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA745291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA303686OtherBLUE SHIELD PIN
PA303686OtherBLUE SHIELD PIN