Provider Demographics
NPI:1265815294
Name:OPENBIOME
Entity Type:Organization
Organization Name:OPENBIOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-575-2201
Mailing Address - Street 1:196 BOSTON AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 BOSTON AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4236
Practice Address - Country:US
Practice Address - Phone:857-313-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory