Provider Demographics
NPI:1548871783
Name:EBDL LLC
Entity type:Organization
Organization Name:EBDL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADERA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AL JUBORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-345-4400
Mailing Address - Street 1:4701 MELBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2540
Mailing Address - Country:US
Mailing Address - Phone:301-345-4400
Mailing Address - Fax:
Practice Address - Street 1:4701 MELBOURNE PL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2540
Practice Address - Country:US
Practice Address - Phone:301-345-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory