Provider Demographics
NPI:1376312272
Name:CAROLINA DIAGNOSTICS LAB
Entity Type:Organization
Organization Name:CAROLINA DIAGNOSTICS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:TYAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-868-8343
Mailing Address - Street 1:517 PYLON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1414
Mailing Address - Country:US
Mailing Address - Phone:410-868-8343
Mailing Address - Fax:
Practice Address - Street 1:517 PYLON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1414
Practice Address - Country:US
Practice Address - Phone:410-868-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory