Provider Demographics
NPI:1689923989
Name:LABORATORY RX, LLC
Entity Type:Organization
Organization Name:LABORATORY RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AURA
Authorized Official - Middle Name:
Authorized Official - Last Name:IONITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-522-2727
Mailing Address - Street 1:217 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3825
Mailing Address - Country:US
Mailing Address - Phone:410-698-2665
Mailing Address - Fax:
Practice Address - Street 1:92 THOMAS JOHNSON DR STE 205
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4403
Practice Address - Country:US
Practice Address - Phone:240-815-5449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207ZP0105X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21D2138383OtherCLIA
MD2726OtherLAB CERTIFICATION