Provider Demographics
NPI:1346475167
Name:CHESTER RIVER HEALTH LAB
Entity type:Organization
Organization Name:CHESTER RIVER HEALTH LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PATIENT FINANIAL SVCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARDELLA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-810-5192
Mailing Address - Street 1:100 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1435
Mailing Address - Country:US
Mailing Address - Phone:410-778-3300
Mailing Address - Fax:410-778-7650
Practice Address - Street 1:6602 CHURCH HILL RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2310
Practice Address - Country:US
Practice Address - Phone:410-778-3300
Practice Address - Fax:410-778-7650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTER RIVER HOSPITAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-22
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D0220377291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGS04Medicare PIN