Provider Demographics
NPI:1841503067
Name:MOLECULAR MS DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:MOLECULAR MS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAGIERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-383-0811
Mailing Address - Street 1:712 OAKLAWN AVENUE, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2858
Mailing Address - Country:US
Mailing Address - Phone:401-383-0811
Mailing Address - Fax:401-533-9837
Practice Address - Street 1:712 OAKLAWN AVE STE 6
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2858
Practice Address - Country:US
Practice Address - Phone:401-383-0811
Practice Address - Fax:401-533-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCI00689291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory