Provider Demographics
NPI:1952339608
Name:MD DIAGNOSTIC LAB INC
Entity Type:Organization
Organization Name:MD DIAGNOSTIC LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RBS,RCS, CCT
Authorized Official - Phone:305-264-0045
Mailing Address - Street 1:1302 S.W. 142 CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184
Mailing Address - Country:US
Mailing Address - Phone:305-984-7906
Mailing Address - Fax:305-229-9456
Practice Address - Street 1:7229A CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1401
Practice Address - Country:US
Practice Address - Phone:305-264-0045
Practice Address - Fax:305-229-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1440Medicare ID - Type UnspecifiedIDTF