Provider Demographics
NPI:1528759982
Name:ADI THERAPEUTICS INC
Entity type:Organization
Organization Name:ADI THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHARAJ-LOWTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-803-5814
Mailing Address - Street 1:11998 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1044
Mailing Address - Country:US
Mailing Address - Phone:443-803-5814
Mailing Address - Fax:410-531-2972
Practice Address - Street 1:807 E BALTIMORE ST STE 2B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5387
Practice Address - Country:US
Practice Address - Phone:443-717-1729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)