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General NPI Number Information
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NPI Number | 1538618632
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Entity Type | Organization
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Legal Business Name | ADVAGENIX
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 9430 KEY WEST AVE SUITE 130
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City | ROCKVILLE
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State | MD
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Zip | 20850-3324
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Country | US
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Telephone | 301-358-3564
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Fax | 240-747-7300
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Provider Business Mailing Address
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Address Line | 9430 KEY WEST AVE SUITE 130
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City | ROCKVILLE
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State | MD
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Zip | 20850-3324
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Country | US
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Telephone | 301-358-3564
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Fax | 240-747-7300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM G KEARNS
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Credential |
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Telephone | 301-358-3564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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