Provider Demographics
NPI:1538618632
Name:ADVAGENIX
Entity type:Organization
Organization Name:ADVAGENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-358-3564
Mailing Address - Street 1:9430 KEY WEST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3324
Mailing Address - Country:US
Mailing Address - Phone:301-358-3564
Mailing Address - Fax:240-747-7300
Practice Address - Street 1:9430 KEY WEST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3324
Practice Address - Country:US
Practice Address - Phone:301-358-3564
Practice Address - Fax:240-747-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics