Organization
PRIME DIAGNOSTICS
Active
Organization
PRIME DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUJWALA PUTTAGUNTA BOPPUDI MS, MBA (PRESIDENT)
(301) 459-5200
Entity
Organization
Contact information
Practice address
4300 FORBES BLVD, LANHAM, MD 20706-4314
(301) 459-5200
(301) 459-5400
Mailing address
4451 BROOKFIELD CORPORATE DR STE 205, CHANTILLY, VA 20151-1693
(703) 378-8100
(703) 378-8101
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
21-D1057808
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010400635
—
VA
05
—
039531500
—
DC
05
—
412222400
—
MD
Enumeration date
07/07/2006
Last updated
02/17/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up