Provider Demographics
NPI:1548287220
Name:SUBURBAN DIAGNOSTIC LABS
Entity type:Organization
Organization Name:SUBURBAN DIAGNOSTIC LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-320-9680
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-0155
Mailing Address - Country:US
Mailing Address - Phone:781-320-9680
Mailing Address - Fax:781-329-6929
Practice Address - Street 1:82 FOREST ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3105
Practice Address - Country:US
Practice Address - Phone:781-320-9680
Practice Address - Fax:781-329-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44852471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA025669Medicare ID - Type Unspecified