Provider Demographics
NPI:1578040705
Name:GENTEST DIAGNOSTICS INC
Entity Type:Organization
Organization Name:GENTEST DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-302-8491
Mailing Address - Street 1:13341 OLD ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13341 OLD ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7734
Practice Address - Country:US
Practice Address - Phone:202-302-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty