Provider Demographics
NPI:1154171080
Name:AMG LAB AND DIAGNOSTICS
Entity type:Organization
Organization Name:AMG LAB AND DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-707-7205
Mailing Address - Street 1:9746 LUGUNA RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3768
Mailing Address - Country:US
Mailing Address - Phone:443-707-7205
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK RD FL 8
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6035
Practice Address - Country:US
Practice Address - Phone:443-707-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory