Provider Demographics
NPI:1184620775
Name:DIAGNOSTIC LABORATORY MEDICINE, INC
Entity type:Organization
Organization Name:DIAGNOSTIC LABORATORY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-582-6248
Mailing Address - Street 1:14 CROSBY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1451
Mailing Address - Country:US
Mailing Address - Phone:800-582-6248
Mailing Address - Fax:781-275-9689
Practice Address - Street 1:14 CROSBY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1451
Practice Address - Country:US
Practice Address - Phone:800-582-6248
Practice Address - Fax:781-275-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2373291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA25143OtherFALLON
TX35-00071OtherUNITED HEALTHCARE
MA800856OtherHARVARD PILGRIM
TX34-00008OtherUNITED HEALTHCARE EVERCAR
MA22-8019OtherBLUE CROSS
MA802319OtherTUFTS
MA0801801Medicaid
MA0801801Medicaid