Provider Demographics
NPI:1447774641
Name:METAMARK GENETICS, INC
Entity Type:Organization
Organization Name:METAMARK GENETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHANDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-715-3805
Mailing Address - Street 1:8000 VIRGINIA MANOR ROAD SUITE 170
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:855-420-8243
Mailing Address - Fax:301-259-5781
Practice Address - Street 1:1912 TW ALEXANDER DRIVE ROOMS 243 & 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27709
Practice Address - Country:US
Practice Address - Phone:855-420-8243
Practice Address - Fax:301-259-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2674291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D2130056OtherCMS