Provider Demographics
NPI:1386938413
Name:PERINATAL DIAGNOSTIX, LLC
Entity type:Organization
Organization Name:PERINATAL DIAGNOSTIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ACHILLES
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:ATHANASSIOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-579-9496
Mailing Address - Street 1:167 BELCHER DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1278
Mailing Address - Country:US
Mailing Address - Phone:978-579-9496
Mailing Address - Fax:978-579-9496
Practice Address - Street 1:167 BELCHER DR
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1278
Practice Address - Country:US
Practice Address - Phone:978-579-9496
Practice Address - Fax:978-579-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3167470Medicaid
MA3167470Medicaid