Provider Demographics
NPI:1881996775
Name:MACROLAB LLC
Entity type:Organization
Organization Name:MACROLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-978-1993
Mailing Address - Street 1:1310 INDUSTRIAL HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4030
Mailing Address - Country:US
Mailing Address - Phone:267-978-1993
Mailing Address - Fax:
Practice Address - Street 1:1310 INDUSTRIAL HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4030
Practice Address - Country:US
Practice Address - Phone:267-978-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D2016029291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
39D2016029OtherCLIA