Organization · Type 2 NPI

The Commonwealth of Massachusetts

Clinical Medical Laboratory · Boston, MA

NPI number 1053463448 Active

Practice location

305 South St
Boston, MA 02130-3515

Specialties and licenses

Taxonomy	Code	License
Clinical Medical Laboratory Primary	291U00000X	NA (MA)

Clinical Medical Laboratory: (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to det…

4 other providers at this address

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NPI record

NPI: 1053463448
Entity type: Organization (Type 2)
Issued: Jan 17, 2007
Last updated: May 18, 2026
Status: Active
Subpart: Yes of The Commonwealth of Massachusetts

Other names

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Childhood Lead Screening Laboratory · doing business as

Authorized official

Matthew Courchene
Chief Financial Officer
(617) 624-5309

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1053463448

The Commonwealth of Massachusetts's National Provider Identifier is 1053463448, issued on Jan 17, 2007. The primary taxonomy on file is Clinical Medical Laboratory (291U00000X), and the practice location is in Boston, MA. The record was last updated on May 18, 2026.