Provider Demographics
NPI:1518458660
Name:P4 DIAGNOSTIX LLC
Entity Type:Organization
Organization Name:P4 DIAGNOSTIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
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 RD STE 170
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4230
Mailing Address - Country:US
Mailing Address - Phone:855-420-8243
Mailing Address - Fax:301-259-5781
Practice Address - Street 1:8000 VIRGINIA MANOR RD STE 170
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-4230
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:2018-05-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty