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General NPI Number Information
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NPI Number | 1043631377
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Entity Type | Organization
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Legal Business Name | METAMARK GENETICS, INC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 245 FIRST ST SUITE 150
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1200
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Country | US
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Telephone | 617-583-1400
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Fax | 617-583-1401
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Provider Business Mailing Address
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Address Line | 245 FIRST ST SUITE 150
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City | CAMBRIDGE
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State | MA
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Zip | 02142-1200
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Country | US
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Telephone | 617-583-1400
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Fax | 617-583-1401
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Authorized Official
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Title or Position | CEO
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Name | SATHISH KOTHANDARAM
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Credential |
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Telephone | 301-715-3805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 3356
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License Number State | MA
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