Healthcare Provider Details

I. General information

NPI: 1902474653
Provider Name (Legal Business Name): SEMA4 OPCO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SOUTHFIELD AVE
STAMFORD CT
06902-7229
US

IV. Provider business mailing address

333 LUDLOW ST FL TOWER8
STAMFORD CT
06902-6987
US

V. Phone/Fax

Practice location:
  • Phone: 800-298-6470
  • Fax:
Mailing address:
  • Phone: 475-333-3621
  • Fax: 475-333-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE WATIMAR
Title or Position: PAYOR ANALYST
Credential:
Phone: 240-429-3142