Provider Demographics
NPI:1780638916
Name:LIFELINE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:LIFELINE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:STANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:800-610-2203
Mailing Address - Street 1:4320 LYNN BURKE RD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-9231
Mailing Address - Country:US
Mailing Address - Phone:800-610-2203
Mailing Address - Fax:800-610-2204
Practice Address - Street 1:4320 LYNN BURKE RD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:MD
Practice Address - Zip Code:21770-9231
Practice Address - Country:US
Practice Address - Phone:800-610-2203
Practice Address - Fax:800-610-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL003371246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty