Medford Medical Laboratory Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

2191 Issued in MA

Legal business name

MEDFORD MEDICAL LABORATORY INC.

Practice address

0 Governors Ave
B-2
Medford, MA 02155-3025

Phone

(781) 395-0518

Fax

(781) 391-0040

NPI assigned

Dec 17, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Lawrence Chapper, MT

Title

President

Phone

(781) 395-0518

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104802529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE",
            "address_2": "B-2",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553025",
            "telephone_number": "781-395-0518",
            "fax_number": "781-391-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0 GOVERNORS AVE",
            "address_2": "B-2",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553025",
            "telephone_number": "781-395-0518",
            "fax_number": "781-391-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFORD MEDICAL LABORATORY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAPPER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-395-0518",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MA",
            "license": "2191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800473",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Medford, MA
• Providers in Medford, MA by specialty
• Clinical Medical Laboratory in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.