Provider Demographics
NPI:1851579148
Name:DEPARTMENT OF HEALTH-PUBLIC HEALTH LABORATORY
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH-PUBLIC HEALTH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-727-8957
Mailing Address - Street 1:300 INDIANA AVE NW
Mailing Address - Street 2:SUITE 6154
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2106
Mailing Address - Country:US
Mailing Address - Phone:202-727-8956
Mailing Address - Fax:202-724-3927
Practice Address - Street 1:300 INDIANA AVE NW
Practice Address - Street 2:SUITE 6154
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2106
Practice Address - Country:US
Practice Address - Phone:202-727-8956
Practice Address - Fax:202-724-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFDC-D020291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory