Provider Demographics
NPI:1689206112
Name:APPLIED IMMUNOGENETICS LABORATORY
Entity Type:Organization
Organization Name:APPLIED IMMUNOGENETICS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-668-7242
Mailing Address - Street 1:11419 CRONRIDGE DR STE 17
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6283
Mailing Address - Country:US
Mailing Address - Phone:443-668-7242
Mailing Address - Fax:
Practice Address - Street 1:11419 CRONRIDGE DR STE 17
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6283
Practice Address - Country:US
Practice Address - Phone:443-668-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory