Provider Demographics
NPI:1699421966
Name:RESINNOVA CLINICAL DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:RESINNOVA CLINICAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-221-3830
Mailing Address - Street 1:5640 FISHERS LN STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2179
Mailing Address - Country:US
Mailing Address - Phone:240-221-3830
Mailing Address - Fax:240-617-4473
Practice Address - Street 1:321 BALLENGER CENTER DR STE 235
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4568
Practice Address - Country:US
Practice Address - Phone:240-221-3830
Practice Address - Fax:240-617-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory