Provider Demographics
NPI:1487374872
Name:EPEC LABS
Entity type:Organization
Organization Name:EPEC LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEKEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-419-9428
Mailing Address - Street 1:9110 PHILADELPHIA RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4325
Mailing Address - Country:US
Mailing Address - Phone:443-559-8354
Mailing Address - Fax:
Practice Address - Street 1:9110 PHILADELPHIA RD STE 210
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4325
Practice Address - Country:US
Practice Address - Phone:443-559-8354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD799594600Medicaid