Organization
LABORATORY FOR CLINICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER MICHAEL MCNICHOLAS (ADMINISTRATIVE DIRECTOR)
(978) 535-3317
Entity
Organization
Contact information
Practice address
200 CORPORATE PL, SUITE #7, PEABODY, MA 01960-3840
(978) 535-3317
(978) 535-1934
Mailing address
200 CORPORATE PL, SUITE #7, PEABODY, MA 01960-3840
(978) 535-3317
(978) 535-1934
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
2404
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0803685
—
MA
01
—
800523
HARVARD PILGRIM PROVIDER
MA
01
—
804004
TUFTS PROVIDER #
MA
01
—
LA228184
BLUE CROSS PROVIDER #
MA
Enumeration date
04/03/2007
Last updated
08/22/2020
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