Provider Demographics
NPI:1740408418
Name:QUALITECH LABORATORY
Entity Type:Organization
Organization Name:QUALITECH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-383-4615
Mailing Address - Street 1:2600 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-7804
Mailing Address - Country:US
Mailing Address - Phone:410-383-4615
Mailing Address - Fax:410-383-4606
Practice Address - Street 1:2600 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7804
Practice Address - Country:US
Practice Address - Phone:410-383-4615
Practice Address - Fax:410-383-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
372QMedicare ID - Type Unspecified