Provider Demographics
NPI:1851863138
Name:PROTEAN BIODIAGNOSTICS INC
Entity Type:Organization
Organization Name:PROTEAN BIODIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGLIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-242-9682
Mailing Address - Street 1:7573 LAUREATE BLVD UNIT 1307
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7826
Mailing Address - Country:US
Mailing Address - Phone:754-732-6187
Mailing Address - Fax:877-764-7628
Practice Address - Street 1:6555 SANGER RD STE 232
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7585
Practice Address - Country:US
Practice Address - Phone:542-429-6827
Practice Address - Fax:877-764-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1558659649OtherNPI