Organization
ALPHA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL CHIKVASHVILI PHD (PRESIDENT-CEO)
(410) 363-4301
Entity
Organization
Contact information
Practice address
9 GWYNNS MILL CT, SUITE F, OWINGS MILLS, MD 21117-3527
(410) 363-4301
(410) 363-4301
Mailing address
9 GWYNNS MILL CT, SUITE F, OWINGS MILLS, MD 21117-3527
(410) 363-4301
(410) 363-4301
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
21D1066645
MD
291U00000X
Clinical Medical Laboratory
39D2043923
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2819
FEDERAL BLUE SHIELD
MD
05
—
412773100
—
MD
01
—
72WHAL
CAREFIRST
MD
Enumeration date
04/10/2007
Last updated
09/07/2012
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