Odet Diagnostic Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ODET DIAGNOSTIC LABORATORY LLC

Practice address

5906 Forum SQ
Frederick, MD 21703-2890

Phone

(919) 924-2240

NPI assigned

Jun 30, 2021

Organization subpart

No

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

Authorized official

Name

Bridget Odetuyi, LPN

Title

Owner

Phone

(919) 924-2240

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1386214369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5906 FORUM SQ",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217032890",
            "telephone_number": "919-924-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5906 FORUM SQ",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217032890",
            "telephone_number": "919-924-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODET DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "ODETUYI",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-924-2240",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Frederick, MD
• Providers in Frederick, MD by specialty
• Clinical Medical Laboratory in Maryland

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