Organization
CAROLINA MEDICAL LAB GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OSAMA IDLIBI (VICE PRESIDENT)
(704) 598-8818
Entity
Organization
Contact information
Practice address
1815 BACK CREEK DR, CHARLOTTE, NC 28213-2159
(704) 598-8818
Mailing address
1815 BACK CREEK DR, CHARLOTTE, NC 28213-2159
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
34D0946272
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7001214
—
NC
Enumeration date
06/15/2005
Last updated
07/27/2009
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