Provider Demographics
NPI:1659900348
Name:MICROGEN HEALTH, INC
Entity Type:Organization
Organization Name:MICROGEN HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGADEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANJANAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-775-1973
Mailing Address - Street 1:14225 SULLYFIELD CIR STE E
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1688
Mailing Address - Country:US
Mailing Address - Phone:571-775-1973
Mailing Address - Fax:571-775-2012
Practice Address - Street 1:14225 SULLYFIELD CIR STE E
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1688
Practice Address - Country:US
Practice Address - Phone:571-775-1973
Practice Address - Fax:571-775-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49D2178444OtherCLIA