Provider Demographics
NPI:1487632998
Name:GENEDX LLC
Entity Type:Organization
Organization Name:GENEDX LLC
Other - Org Name:GENEDX, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-519-2100
Mailing Address - Street 1:207 PERRY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2142
Mailing Address - Country:US
Mailing Address - Phone:301-519-2100
Mailing Address - Fax:301-947-4251
Practice Address - Street 1:207 PERRY PKWY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2142
Practice Address - Country:US
Practice Address - Phone:301-519-2100
Practice Address - Fax:301-947-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
870020170100000X
MD953291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21D0969951OtherCMS CLIA CERTIFICATION
MD953OtherMARYLAND STATE LICENSE