Provider Demographics
NPI:1851707186
Name:INTEGRATED CELLULAR AND MOLECULAR DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:INTEGRATED CELLULAR AND MOLECULAR DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-522-4263
Mailing Address - Street 1:6305 IVY LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6323
Mailing Address - Country:US
Mailing Address - Phone:844-522-4263
Mailing Address - Fax:301-363-1099
Practice Address - Street 1:6305 IVY LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6323
Practice Address - Country:US
Practice Address - Phone:844-522-4263
Practice Address - Fax:301-363-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory