Provider Demographics
NPI:1710300579
Name:PATRIOT MEDICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:PATRIOT MEDICAL LABORATORIES LLC
Other - Org Name:CIAN DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOMBABU
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-422-4164
Mailing Address - Street 1:5330 SPECTRUM DR STE I
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7302
Mailing Address - Country:US
Mailing Address - Phone:240-396-4343
Mailing Address - Fax:240-396-4345
Practice Address - Street 1:5330 SPECTRUM DR STE I
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7302
Practice Address - Country:US
Practice Address - Phone:240-396-4343
Practice Address - Fax:240-396-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D2074025291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory