Provider Demographics
NPI:1184971855
Name:EXPRESSION PATHOLOGY INCORPORATED
Entity type:Organization
Organization Name:EXPRESSION PATHOLOGY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:GUIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-977-3654
Mailing Address - Street 1:9620 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3338
Mailing Address - Country:US
Mailing Address - Phone:301-977-3654
Mailing Address - Fax:301-926-9283
Practice Address - Street 1:9620 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3338
Practice Address - Country:US
Practice Address - Phone:301-977-3654
Practice Address - Fax:301-926-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D2043150291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1872OtherMEDICAL LABORATORY PERMIT
21D2043150OtherCLIA ID NUMBER