Organization
BRADDOCK MEDICAL GROUP
Active
Other names
Braddock Medical Group Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS E CHAPPELL MD (MEDICAL DIRECTOR)
(301) 722-3111
Entity
Organization
Contact information
Practice address
912 SETON DR, CUMBERLAND, MD 21502-1818
(301) 722-3111
(301) 722-5135
Mailing address
912 SETON DR, CUMBERLAND, MD 21502-1818
(301) 722-3111
(301) 722-5135
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
830420
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011509001
—
WV
Enumeration date
10/26/2006
Last updated
09/16/2008
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