Provider Demographics
NPI:1821740572
Name:MOLECULAR MICROBIOLOGY LAB MML INC
Entity Type:Organization
Organization Name:MOLECULAR MICROBIOLOGY LAB MML INC
Other - Org Name:MOLECULAR MICROBIOLOGY LAB
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:IDLIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-721-6622
Mailing Address - Street 1:1815 BACK CREEK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2159
Mailing Address - Country:US
Mailing Address - Phone:980-721-6622
Mailing Address - Fax:
Practice Address - Street 1:1815 BACK CREEK DR STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-2159
Practice Address - Country:US
Practice Address - Phone:980-721-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory