Provider Demographics
NPI:1447535901
Name:SUBURBAN MEDICAL LABORATORY
Entity type:Organization
Organization Name:SUBURBAN MEDICAL LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-752-7300
Mailing Address - Street 1:671 OHIO PIKE, #K
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245
Mailing Address - Country:US
Mailing Address - Phone:513-752-7300
Mailing Address - Fax:
Practice Address - Street 1:6800 VIRGINIA MANOR RD
Practice Address - Street 2:
Practice Address - City:BETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705
Practice Address - Country:US
Practice Address - Phone:216-409-7394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0904468291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory