Organization
CHESAPEAKE DIAGNOSTIC LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHLA MOSHIRI M.D. (MEDICAL DIRECTOR)
(410) 560-5800
Entity
Organization
Contact information
Practice address
110 OLD PADONIA RD, STE 301, COCKEYSVILLE HUNT VALLEY, MD 21030-4948
(410) 560-5800
Mailing address
110 OLD PADONIA RD, STE 301, COCKEYSVILLE HUNT VALLEY, MD 21030-4948
(410) 560-5800
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
027547D
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21D0704925
CLIA #
MD
05
—
800160000
—
MD
Enumeration date
06/21/2005
Last updated
12/28/2010
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