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Organization

LABORATORY FOR CLINICAL MEDICINE

Active
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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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