Provider Demographics
NPI:1043631377
Name:METAMARK GENETICS, INC
Entity type:Organization
Organization Name:METAMARK GENETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHANDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-715-3805
Mailing Address - Street 1:245 FIRST ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1200
Mailing Address - Country:US
Mailing Address - Phone:617-583-1400
Mailing Address - Fax:617-583-1401
Practice Address - Street 1:245 FIRST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1200
Practice Address - Country:US
Practice Address - Phone:617-583-1400
Practice Address - Fax:617-583-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3356291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory