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NPI Code Detail

MEDICARE: CORRELAGEN DIAGNOSTICS, INC.

MEDICARE: CORRELAGEN 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122D1044516OTHERCLIA

General Provider Information

NPI Number : 1912970252
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORRELAGEN DIAGNOSTICS, INC.
Provider Business Mailing Address
First Line : PO BOX 2240
Second Line :
City : BURLINGTON
State : NC
Zip : 27216-2240
Country : US
Telephone Number : 800-222-7566
Fax Number : 336-436-1048
Provider Business Practice Location Address
First Line : 3400 COMPUTER DR
Second Line : STE 100
City : WESTBOROUGH
State : MA
Zip : 01581-1771
Country : US
Telephone Number : 866-647-0735
Fax Number :
Authorized Official
Title or Position : VP
Name : KIMBERLY WILLIAMS
Credential :
Telephone Number : 800-222-7566
Provider Enumeration Date : 02/08/2006
Last Update Date : 01/02/2014

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Directions to “CORRELAGEN DIAGNOSTICS, INC. ” Practice Location

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