Provider Demographics
NPI:1730195215
Name:TRISTAR MEDICAL LAB, INC
Entity type:Organization
Organization Name:TRISTAR MEDICAL LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAFDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-550-7800
Mailing Address - Street 1:8350C TERMINAL RD
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1422
Mailing Address - Country:US
Mailing Address - Phone:703-550-7800
Mailing Address - Fax:703-550-7864
Practice Address - Street 1:8350C TERMINAL RD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1422
Practice Address - Country:US
Practice Address - Phone:703-550-7800
Practice Address - Fax:703-550-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4981090Medicaid
VA4981090Medicaid