Provider Demographics
NPI:1629183454
Name:MEDICAL ASSOCIATES LABORATORY
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-324-0447
Mailing Address - Street 1:770 WELCH RD STE 380
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1523
Mailing Address - Country:US
Mailing Address - Phone:650-324-0447
Mailing Address - Fax:650-324-2557
Practice Address - Street 1:770 WELCH RD STE 380
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1523
Practice Address - Country:US
Practice Address - Phone:650-324-0447
Practice Address - Fax:650-324-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83670291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G836700Medicare ID - Type UnspecifiedMEDICARE NUMBER