Provider Demographics
NPI:1225783285
Name:NORTHRIUM DIAGNOSTICS
Entity Type:Organization
Organization Name:NORTHRIUM DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMAECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ERONDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-414-1139
Mailing Address - Street 1:7801 OLD BRANCH AVENUE #202
Mailing Address - Street 2:CLINTON
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:443-414-1139
Mailing Address - Fax:
Practice Address - Street 1:7801 OLD BRANCH AVENUE #202
Practice Address - Street 2:CLINTON
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:443-414-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No291U00000XLaboratoriesClinical Medical Laboratory