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General NPI Number Information
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NPI Number | 1437958824
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Entity Type | Organization
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Legal Business Name | GLIOBLASTOMA FOUNDATION
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 701 W MAIN ST
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City | DURHAM
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State | NC
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Zip | 27701-5010
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Country | US
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Telephone | 919-812-5416
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62066
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City | DURHAM
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State | NC
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Zip | 27715-2066
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Country | US
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Telephone | 919-402-1775
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GITA KWATRA
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Credential | PHARMAD, MBA
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Telephone | 919-740-1173
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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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