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NPI Code Detail

MEDICARE: TELOMERE DIAGNOSTICS, INC.

MEDICARE: TELOMERE DIAGNOSTICS, 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1083212351
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELOMERE DIAGNOSTICS, INC.
Provider Business Mailing Address
First Line : 27 DRYDOCK AVE STE 3
Second Line :
City : BOSTON
State : MA
Zip : 02210-2382
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2688 MIDDLEFIELD RD STE A
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-3483
Country : US
Telephone Number : 650-369-0699
Fax Number :
Authorized Official
Title or Position : VP AND GENERAL COUNSEL
Name : MICHAEL ROBBAT
Credential :
Telephone Number : 617-519-6626
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/09/2020

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Directions to “TELOMERE DIAGNOSTICS, INC. ” Practice Location

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