MEDICARE: PARABASE GENOMICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1033454715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARABASE GENOMICS INC

Provider Business Mailing Address
First Line	:	27 DRYDOCK AVE, 2ND FLOOR
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210
Country	:	US
Telephone Number	:	857-288-0838
Fax Number	:	866-604-9369

Provider Business Practice Location Address
First Line	:	27 DRYDOCK AVE
Second Line	:	2ND FLOOR
City	:	BOSTON
State	:	MA
Zip	:	02210-2377
Country	:	US
Telephone Number	:	857-288-0838
Fax Number	:	866-604-9369

Authorized Official
Title or Position	:	CHIEF COMMERCIAL OFFICER
Name	:	MR. GABOR BETHLENDY
Credential	:
Telephone Number	:	857-288-0838

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	06/07/2016

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