Provider Demographics
NPI:1518554450
Name:AMERICAN GENE TECHNOLOGIES INTERNATIONAL INC
Entity Type:Organization
Organization Name:AMERICAN GENE TECHNOLOGIES INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-337-2100
Mailing Address - Street 1:9713 KEY WEST AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3996
Mailing Address - Country:US
Mailing Address - Phone:301-337-2100
Mailing Address - Fax:
Practice Address - Street 1:9713 KEY WEST AVE STE 500-024
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3918
Practice Address - Country:US
Practice Address - Phone:301-337-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory