Healthcare Provider Details

I. General information

NPI: 1265803522
Provider Name (Legal Business Name): EPOCH RESOURCE TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 EMMORTON RD
ABINGDON MD
21009-1625
US

IV. Provider business mailing address

2814 EMMORTON RD
ABINGDON MD
21009-1625
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-6130
  • Fax: 443-420-0021
Mailing address:
  • Phone: 800-637-6130
  • Fax: 443-420-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT GREVERIS
Title or Position: OWNER
Credential:
Phone: 18006376130