Provider Demographics
NPI:1972966075
Name:SUNBLOOM TECH INC
Entity Type:Organization
Organization Name:SUNBLOOM TECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-343-8299
Mailing Address - Street 1:3266 W SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3266 W SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3270
Practice Address - Country:US
Practice Address - Phone:231-355-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD45678914566291U00000X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory