Provider Demographics
NPI:1477094274
Name:LAWRENCE MED LAB LLC
Entity Type:Organization
Organization Name:LAWRENCE MED LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVIT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKOBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-281-1265
Mailing Address - Street 1:395 W CUMMINGS PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6335
Mailing Address - Country:US
Mailing Address - Phone:781-281-1265
Mailing Address - Fax:781-281-1427
Practice Address - Street 1:395 W CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6335
Practice Address - Country:US
Practice Address - Phone:781-281-1265
Practice Address - Fax:781-281-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110123106AMedicaid