Provider Demographics
NPI:1902834583
Name:NATIONAL TOXICOLOGY SERVICES, INC
Entity Type:Organization
Organization Name:NATIONAL TOXICOLOGY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PUNYAMURTULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KISHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-217-8888
Mailing Address - Street 1:3 BALDWIN GREEN CMN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1865
Mailing Address - Country:US
Mailing Address - Phone:781-569-0590
Mailing Address - Fax:781-569-0592
Practice Address - Street 1:3 BALDWIN GREEN CMN
Practice Address - Street 2:SUITE 104
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1865
Practice Address - Country:US
Practice Address - Phone:781-569-0590
Practice Address - Fax:781-569-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2306291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory