Clinical Diagnostic Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CLINICAL DIAGNOSTIC LABORATORIES, LLC

Practice address

44355 Premier PLZ Ste 240
Ashburn, VA 20147-5050

Phone

(703) 430-1111

Fax

(703) 722-3890

NPI assigned

Jan 4, 2018

Organization subpart

No

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

Authorized official

Name

Ibtihaj Awadelkariem

Title

Ceo/Technical Director

Phone

(703) 430-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Daniel Keegan, DC

  • Chiropractor
  • Ashburn, VA
  • NPI 1083786578
  NPD (past)

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1881101475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44355 PREMIER PLZ STE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475050",
            "telephone_number": "703-430-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44355 PREMIER PLZ STE 240",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475050",
            "telephone_number": "703-430-1111",
            "fax_number": "703-722-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL DIAGNOSTIC LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "AWADELKARIEM",
        "authorized_official_first_name": "IBTIHAJ",
        "authorized_official_title_or_position": "CEO/TECHNICAL DIRECTOR",
        "authorized_official_telephone_number": "703-430-1111"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881101475",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://clinicaldiagnosticlab.com/",
            "affiliation": "N",
            "endpointDescription": "https://clinicaldiagnosticlab.com/",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://clinicaldiagnosticlab.com/",
            "address_1": "44355 Premier Plz Ste 240",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201475050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Medical Laboratory in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Clinical Medical Laboratory in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.