Provider Demographics
NPI:1861983033
Name:CHESAPEAKE CLINICAL LABORATORIES, LLC
Entity type:Organization
Organization Name:CHESAPEAKE CLINICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-485-7183
Mailing Address - Street 1:131 S UNION AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3138
Mailing Address - Country:US
Mailing Address - Phone:443-502-1340
Mailing Address - Fax:443-406-3731
Practice Address - Street 1:131 S UNION AVE STE B
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3138
Practice Address - Country:US
Practice Address - Phone:443-502-1340
Practice Address - Fax:443-406-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory