NPIMap

Organization Active NPI

Alpha Clinical Laboratories, LLC

  • Clinical Medical Laboratory
  • Owings Mills, MD
National Provider Identifier
1508089418
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
21D1066645 Issued in MD
Legal business name
ALPHA CLINICAL LABORATORIES, LLC
Practice address
9 Gwynns Mill CT
Suite F
Owings Mills, MD 21117-3527
Phone
(410) 363-4301
Fax
(410) 363-4301
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Authorized official

Name
Dr. Rafael Chikvashvili, PHD
Title
President-Ceo
Phone
(410) 363-4301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 21D1066645 MD Primary
Clinical Medical Laboratory 291U00000X 39D2043923 PA

Addresses

Primary practice location

9 Gwynns Mill CT
Suite F
Owings Mills, MD 21117-3527

Mailing address

9 Gwynns Mill CT
Suite F
Owings Mills, MD 21117-3527
Phone (410) 363-4301

Other identifiers 3

IdentifierTypeStateIssuer
412773100MedicaidMD
2819OtherMDFEDERAL BLUE SHIELD
72WHALOtherMDCAREFIRST

National Provider Directory

National Provider Directory

Locations

443 State St
#A
Hamburg, PA 19526
Phone (484) 662-7960

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1508089418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GWYNNS MILL CT",
            "address_2": "SUITE F",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173527",
            "telephone_number": "410-363-4301",
            "fax_number": "410-363-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 GWYNNS MILL CT",
            "address_2": "SUITE F",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173527",
            "telephone_number": "410-363-4301",
            "fax_number": "410-363-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA CLINICAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "CHIKVASHVILI",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "PRESIDENT-CEO",
        "authorized_official_telephone_number": "410-363-4301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21D1066645",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "39D2043923",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412773100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLUE SHIELD",
            "identifier": "2819",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "72WHAL",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; 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.