Provider Demographics
NPI:1659371680
Name:LABORATORY DIAGNOSTICS INC
Entity type:Organization
Organization Name:LABORATORY DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OROXOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-877-4654
Mailing Address - Street 1:10 ST. PATRICKS DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3500
Mailing Address - Country:US
Mailing Address - Phone:301-870-7001
Mailing Address - Fax:301-870-6697
Practice Address - Street 1:7503 SURRATTS ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-870-7001
Practice Address - Fax:301-870-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD512011Medicare PIN