Provider Demographics
NPI:1922424969
Name:THERANOSTICS HEALTH INC.
Entity Type:Organization
Organization Name:THERANOSTICS HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HENCIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-251-4443
Mailing Address - Street 1:15010 BROSCHART RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6365
Mailing Address - Country:US
Mailing Address - Phone:301-251-4443
Mailing Address - Fax:301-251-4446
Practice Address - Street 1:15010 BROSCHART RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6365
Practice Address - Country:US
Practice Address - Phone:301-251-4443
Practice Address - Fax:301-251-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52868291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8006327OtherLAP - COLLEGE OF AMERICAN PATHOLOOGISTS (CAP)
MD21D1084125OtherCLIA
MD1618045OtherAU ID - COLLEGE OF AMERICAN PATHOLOGISTS (CAP)