NPIMap

Organization Active NPI

Maryland Success Academy LLC

Doing business as Maryland Success Lab, LLC

  • Clinical Medical Laboratory
  • Randallstown, MD
National Provider Identifier
1295344505
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MARYLAND SUCCESS ACADEMY LLC
Doing business as
Maryland Success Lab, LLC
Practice address
9854 Liberty Rd
Suite E
Randallstown, MD 21133-2113
Phone
(443) 353-9729
NPI assigned
Jul 23, 2020
Last updated
Oct 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Authorized official

Name
Jennifer HubbardNPI 1043836885
Title
President
Phone
(443) 353-9729

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X NU
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

9854 Liberty Rd
Suite E
Randallstown, MD 21133-2113

Mailing address

9854 Liberty Rd
Suite E
Randallstown, MD 21133-2058
Phone (443) 353-9729

Other names 1

  • Maryland Success Lab, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

9854 Liberty Rd
Ste E
Randallstown, MD 21133
Phone (443) 353-9729

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1295344505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9854 LIBERTY RD",
            "address_2": "SUITE E",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211332058",
            "telephone_number": "443-353-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9854 LIBERTY RD",
            "address_2": "SUITE E",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211332113",
            "telephone_number": "443-353-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND SUCCESS ACADEMY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-353-9729"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maryland Success Lab, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.