1447774641 NPI number — METAMARK GENETICS, INC

Table of content: (NPI 1447774641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447774641 NPI number — METAMARK GENETICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METAMARK GENETICS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447774641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 VIRGINIA MANOR ROAD SUITE 170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-420-8243
Provider Business Mailing Address Fax Number:
301-259-5781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1912 TW ALEXANDER DRIVE ROOMS 243 & 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-420-8243
Provider Business Practice Location Address Fax Number:
301-259-5781
Provider Enumeration Date:
07/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KOTHANDARAM
Authorized Official First Name:
SATHISH
Authorized Official Middle Name:
Authorized Official Title or Position:
C.E.O
Authorized Official Telephone Number:
301-715-3805

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  2674 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34D2130056 . This is a "CMS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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