Provider Demographics
NPI:1699366914
Name:EXPRESS MOBILE LAB
Entity Type:Organization
Organization Name:EXPRESS MOBILE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERREONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:703-899-7002
Mailing Address - Street 1:10 GOLDEN WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-6972
Mailing Address - Country:US
Mailing Address - Phone:800-282-9033
Mailing Address - Fax:
Practice Address - Street 1:10 GOLDEN WILLOW WAY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-6972
Practice Address - Country:US
Practice Address - Phone:800-282-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty