Provider Demographics
NPI:1598827636
Name:L2 DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:L2 DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR OF MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAMULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-785-2840
Mailing Address - Street 1:P.O. BOX 208031
Mailing Address - Street 2:300 CEDAR ST. TAC ROOM S-525
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8031
Mailing Address - Country:US
Mailing Address - Phone:203-737-1952
Mailing Address - Fax:
Practice Address - Street 1:300 CEDAR ST. TAC ROOM S-525
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8031
Practice Address - Country:US
Practice Address - Phone:203-737-1952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT07DO943606OtherCLIA
CTCU5316OtherHEALTHNET
CT709946OtherCT CARE
CTA914266OtherOXFORD