Provider Demographics
NPI:1265714091
Name:FOUNDATION MEDICINE, INC.
Entity type:Organization
Organization Name:FOUNDATION MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER, REVENUE
Authorized Official - Prefix:MS
Authorized Official - First Name:BAHAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-707-6322
Mailing Address - Street 1:150 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2115
Mailing Address - Country:US
Mailing Address - Phone:617-418-2200
Mailing Address - Fax:
Practice Address - Street 1:150 2ND ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2115
Practice Address - Country:US
Practice Address - Phone:617-418-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22D2027531291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory