Provider Demographics
NPI:1982010963
Name:AERODIAGNOSTICS LLC
Entity Type:Organization
Organization Name:AERODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:617-584-8411
Mailing Address - Street 1:1 CRANBERRY HL
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7394
Mailing Address - Country:US
Mailing Address - Phone:617-608-3832
Mailing Address - Fax:617-860-6617
Practice Address - Street 1:1 CRANBERRY HL
Practice Address - Street 2:SUITE 303A
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7394
Practice Address - Country:US
Practice Address - Phone:617-608-3832
Practice Address - Fax:617-860-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001139818291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory