Provider Demographics
NPI:1750669065
Name:PHLEBOTOMY ON WHEELS
Entity Type:Organization
Organization Name:PHLEBOTOMY ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-413-1144
Mailing Address - Street 1:4112 GLENARM AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2528
Mailing Address - Country:US
Mailing Address - Phone:443-413-1144
Mailing Address - Fax:
Practice Address - Street 1:4112 GLENARM AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2528
Practice Address - Country:US
Practice Address - Phone:443-413-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHLEBOTOMY ON WHEELS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20-0229R04246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20-0229R04OtherNPA