Provider Demographics
NPI:1700825114
Name:FRIENDS MEDICAL LABORATORY INC.
Entity Type:Organization
Organization Name:FRIENDS MEDICAL LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIPLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-247-4417
Mailing Address - Street 1:5820 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-4402
Mailing Address - Country:US
Mailing Address - Phone:410-247-4417
Mailing Address - Fax:410-247-4426
Practice Address - Street 1:5820 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-4402
Practice Address - Country:US
Practice Address - Phone:410-247-4417
Practice Address - Fax:410-247-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE10034653Medicaid
MD439938200Medicaid
DE10034653Medicaid