Provider Demographics
NPI:1407328073
Name:TRI-STATE HEALTH LABORATORY, LLC
Entity Type:Organization
Organization Name:TRI-STATE HEALTH LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-368-2563
Mailing Address - Street 1:107 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5326
Mailing Address - Country:US
Mailing Address - Phone:410-392-6408
Mailing Address - Fax:410-392-6409
Practice Address - Street 1:107 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5326
Practice Address - Country:US
Practice Address - Phone:410-392-6408
Practice Address - Fax:410-392-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory