Provider Demographics
NPI:1508481904
Name:MEDLAB ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MEDLAB ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MELARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-536-0254
Mailing Address - Street 1:149 ESTERBROOK AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3240
Mailing Address - Country:US
Mailing Address - Phone:321-536-0254
Mailing Address - Fax:
Practice Address - Street 1:6120 HANGING MOSS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3701
Practice Address - Country:US
Practice Address - Phone:321-536-0254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty