MEDICARE: FOUNDATION MEDICINE, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34D2044309	OTHER	NC	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508215922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION MEDICINE, INC.

Provider Business Mailing Address
First Line	:	150 2ND ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02141-2115
Country	:	US
Telephone Number	:	617-418-2200
Fax Number	:	617-418-2290

Provider Business Practice Location Address
First Line	:	7010 KIT CREEK RD
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9761
Country	:	US
Telephone Number	:	617-418-2200
Fax Number	:

Authorized Official
Title or Position	:	SENIOR MANAGER, REVENUE
Name	:	BAHAREH JAFARI
Credential	:
Telephone Number	:	781-707-6322

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	11/10/2020

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