Provider Demographics
NPI:1922432442
Name:METAGENES
Entity Type:Organization
Organization Name:METAGENES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DE FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-660-6382
Mailing Address - Street 1:22 N MULBERRY ST
Mailing Address - Street 2:LOFT 210
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4870
Mailing Address - Country:US
Mailing Address - Phone:301-660-6382
Mailing Address - Fax:240-597-2174
Practice Address - Street 1:22 N MULBERRY ST
Practice Address - Street 2:LOFT 210
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4870
Practice Address - Country:US
Practice Address - Phone:301-660-6382
Practice Address - Fax:240-597-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition