Provider Demographics
NPI:1356061477
Name:MARIN MEDICAL LABORATORIES
Entity type:Organization
Organization Name:MARIN MEDICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEDAR
Authorized Official - Middle Name:CHE
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-7174
Mailing Address - Street 1:1615 HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4338
Mailing Address - Country:US
Mailing Address - Phone:415-209-6983
Mailing Address - Fax:415-898-0870
Practice Address - Street 1:2700 DOLBEER ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4736
Practice Address - Country:US
Practice Address - Phone:707-445-8121
Practice Address - Fax:415-898-0870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIN MEDICAL LABORATORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-30
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty