Provider Demographics
NPI:1396356846
Name:QUALVITA DIAGNOSTICS
Entity Type:Organization
Organization Name:QUALVITA DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:973-856-3631
Mailing Address - Street 1:9101 CHERRY LN STE 213
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1151
Mailing Address - Country:US
Mailing Address - Phone:973-856-3631
Mailing Address - Fax:
Practice Address - Street 1:9101 CHERRY LN STE 213
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1151
Practice Address - Country:US
Practice Address - Phone:973-856-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory