Provider Demographics
NPI:1144590449
Name:COURTAGEN LIFE SCIENCES, INC.
Entity Type:Organization
Organization Name:COURTAGEN LIFE SCIENCES, INC.
Other - Org Name:COURTAGEN DIAGNOSTICS LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-892-7179
Mailing Address - Street 1:8 CABOT RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1004
Mailing Address - Country:US
Mailing Address - Phone:877-395-7608
Mailing Address - Fax:617-249-0394
Practice Address - Street 1:8 CABOT RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1004
Practice Address - Country:US
Practice Address - Phone:877-395-7608
Practice Address - Fax:617-249-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAPPLIED FOR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory