Provider Demographics
NPI:1770295826
Name:MEDICAL AND GENETIC DIAGNOSTICS CORP
Entity type:Organization
Organization Name:MEDICAL AND GENETIC DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-505-8034
Mailing Address - Street 1:807 N HADDON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1749
Mailing Address - Country:US
Mailing Address - Phone:862-505-8034
Mailing Address - Fax:
Practice Address - Street 1:807 N HADDON AVE STE 102
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1749
Practice Address - Country:US
Practice Address - Phone:862-505-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty