Healthcare Provider Details

I. General information

NPI: 1245085430
Provider Name (Legal Business Name): FPCA MOLECULAR LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SOLAREX CT STE B
FREDERICK MD
21703-8624
US

IV. Provider business mailing address

610 SOLAREX CT STE B
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-5500
  • Fax:
Mailing address:
  • Phone: 301-682-5500
  • Fax:

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: MUHAMMAD KHILJI
Title or Position: OWNER
Credential: MD
Phone: 301-682-5500