Provider Demographics
NPI:1568214179
Name:COLLAB DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:COLLAB DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABRATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC(C),MSCCT(ASCP)
Authorized Official - Phone:832-754-6495
Mailing Address - Street 1:750 MAIN ST STE 300A
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2515
Mailing Address - Country:US
Mailing Address - Phone:832-754-6495
Mailing Address - Fax:
Practice Address - Street 1:750 MAIN ST STE 300A
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2515
Practice Address - Country:US
Practice Address - Phone:832-754-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine