Provider Demographics
NPI:1023387701
Name:MEDICINE INVENTION DESIGN INCORPORATION
Entity Type:Organization
Organization Name:MEDICINE INVENTION DESIGN INCORPORATION
Other - Org Name:TELEHEALTH - ONLINE CLINICAL TRIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/SD/PI/SPONSOR/CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:MD / PHD / FAPCR
Authorized Official - Phone:301-222-7143
Mailing Address - Street 1:5545 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2458
Mailing Address - Country:US
Mailing Address - Phone:301-222-7143
Mailing Address - Fax:866-458-0099
Practice Address - Street 1:5545 BURNSIDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2458
Practice Address - Country:US
Practice Address - Phone:301-222-7143
Practice Address - Fax:866-458-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No3336I0012XSuppliersPharmacyInstitutional PharmacyGroup - Multi-Specialty
No3336M0002XSuppliersPharmacyMail Order PharmacyGroup - Multi-Specialty
No3336M0003XSuppliersPharmacyManaged Care Organization PharmacyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty PharmacyGroup - Multi-Specialty
No335G00000XSuppliersMedical Foods SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDIRB00009294OtherHHS-OHRP-IRB
MDIORG0007849OtherHHS-OHRP-IORG
MDD11379922OtherMD-SDAT
MDFWA00015357OtherHHS-OHRP-FWA