Diagnostic Lab of Southern Maryland

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

DIAGNOSTIC LAB OF SOUTHERN MARYLAND

Practice address

3985 Saint Charles Pkwy Ste 200E
Waldorf, MD 20602-2683

Phone

(240) 538-8571

Fax

(240) 607-7229

NPI assigned

Jan 30, 2023

Last updated

Jan 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Teaira MilburnNPI 1851903512

Title

Owner/Provider

Phone

(240) 925-9449

Specialties & licenses 2

Addresses

Locations

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.

• Teaira Geneva Milburn

  • Phlebotomy Technician
  • Waldorf, MD
  • NPI 1851903512
  NPD Authorized official

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1366158719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 LAKEWOOD PL",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021429",
            "telephone_number": "240-538-8571",
            "fax_number": "240-607-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3985 SAINT CHARLES PKWY STE 200E",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022683",
            "telephone_number": "240-538-8571",
            "fax_number": "240-607-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC LAB OF SOUTHERN MARYLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-29",
        "status": "A",
        "authorized_official_last_name": "MILBURN",
        "authorized_official_first_name": "TEAIRA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "240-925-9449"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devine Grace Behavioral Health Center, LLC
• Devote LLC
• Rekeya Lanae Dewberry
• Diabetes and Endocrine Consultants Levy Sharon Misra and Yu PC
• Diagnostic Health Corporation (Diagnostic Health Waldorf)
• Tiffany Dias
• Ashley Laurenne Dickens, PHYSICAL THERAPIST
• Rachel Dietrich
• September Dietrich
• Frank Digiovannantonio, CHT

• Health Service Clinic/Center in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Health Service Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.