Healthcare Provider Details

I. General information

NPI: 1346272101
Provider Name (Legal Business Name): M-SQUARED DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 MINSTREL WAY SUITE 101
COLUMBIA MD
21045-5255
US

IV. Provider business mailing address

7135 MINSTREL WAY SUITE 101
COLUMBIA MD
21045-5255
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-5688
  • Fax: 410-290-5689
Mailing address:
  • Phone: 410-290-5688
  • Fax: 410-290-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM290
License Number StateMD

VIII. Authorized Official

Name: MR. STEVEN F SHIELDS
Title or Position: MANAGER
Credential:
Phone: 804-282-9133