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General NPI Number Information
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NPI Number | 1275939985
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Entity Type | Organization
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Legal Business Name | BIOGENOMICS, LLC
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 502 MCKNIGHT DR STE 200A
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City | KNIGHTDALE
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State | NC
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Zip | 27545-7050
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Country | US
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Telephone | 252-388-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 502 MCKNIGHT DR STE 200
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City | KNIGHTDALE
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State | NC
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Zip | 27545-7050
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Country | US
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Telephone | 919-295-5580
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MAQSOOD AHMED
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Credential | MD
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Telephone | 252-702-0190
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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 | 34D2085246
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License Number State | NC
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