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General NPI Number Information
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NPI Number | 1063823904
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Entity Type | Organization
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Legal Business Name | ADERA LABS, LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 20271 GOLDENROD LN ROOM 2062
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City | GERMANTOWN
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State | MD
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Zip | 20876-4064
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Country | US
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Telephone | 301-317-7160
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Fax | 443-283-4052
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Provider Business Mailing Address
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Address Line | 20271 GOLDENROD LN ROOM 2062
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City | GERMANTOWN
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State | MD
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Zip | 20876-4064
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Country | US
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Telephone | 301-317-7160
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Fax | 443-283-4052
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARK RICIGLIANO
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Credential |
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Telephone | 301-317-7160
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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 |
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License Number State |
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