Organization · Type 2 NPI

The Commonwealth of Massachusetts

Clinical Medical Laboratory · Jamaica Plain, MA

NPI number 1093856965 Active

Practice location

305 South St
Jamaica Plain, MA 02130-3515

Fax (857) 323-8352

Specialties and licenses

Taxonomy	Code	License
Clinical Medical Laboratory Primary	291U00000X	None listed

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

NPI record

NPI: 1093856965
Entity type: Organization (Type 2)
Issued: Feb 12, 2007
Last updated: May 18, 2026
Status: Active
Subpart: Yes of The Commonwealth of Massachusetts

Other names

Sexually Transmitted Infections (sti) 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 1093856965

The Commonwealth of Massachusetts's National Provider Identifier is 1093856965, issued on Feb 12, 2007. The primary taxonomy on file is Clinical Medical Laboratory (291U00000X), and the practice location is in Jamaica Plain, MA. The record was last updated on May 18, 2026.