Organization
CLINICAL LABORATORY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC WARGOTZ M.D. (OWNER)
(301) 552-8118
Entity
Organization
Contact information
Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3595
(301) 552-8118
(301) 498-3074
Mailing address
PO BOX 1147, LAUREL, MD 20725-1147
(301) 498-2922
(301) 498-3074
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260100100
—
MD
01
—
3437
BCBS GROUP PROVIDER #
DC
01
—
W450CL
BCBS GROUP PROVIDER #
MD
Enumeration date
06/03/2006
Last updated
01/25/2012
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