Provider Demographics
NPI:1386148971
Name:CENTOGENE US LLC
Entity type:Organization
Organization Name:CENTOGENE US LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SALES
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-517-0433
Mailing Address - Street 1:99 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4559
Mailing Address - Country:US
Mailing Address - Phone:617-580-2102
Mailing Address - Fax:
Practice Address - Street 1:99 ERIE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4559
Practice Address - Country:US
Practice Address - Phone:781-270-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002910Medicaid
ID192810027Medicaid
OK200884380AMedicaid
SCL00705Medicaid
AK1703293Medicaid
IA1386148971Medicaid
ND1479345Medicaid
UT3016258Medicaid
GA003231019AMedicaid
WI1386148971Medicaid
MI1386148971Medicaid
KS201279250AMedicaid
WA2145227Medicaid
VT6702554Medicaid
WY6ECDF72A26Medicaid
NE10026808100Medicaid
IN300034432Medicaid
99D2019715OtherCLIA
OR01771017-6Medicaid
MA110159144AMedicaid
CO9000178190Medicaid