Personal Genome Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

21D2039282 Issued in MD

Legal business name

PERSONAL GENOME DIAGNOSTICS

Practice address

3600 Boston St Ste 10
Baltimore, MD 21224-5729

Phone

(855) 743-9669

Fax

(443) 602-8833

NPI assigned

Jan 28, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly T Williams

Title

Vice President

Phone

(336) 436-5402

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Laboratory Corporation of America Holdings

  • Clinical Medical Laboratory
  • Cromwell, CT
  • NPI 1700517984

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1043558992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2240",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272162240",
            "telephone_number": "336-222-7566",
            "fax_number": "443-602-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 BOSTON ST STE 10",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212245729",
            "telephone_number": "855-743-9669",
            "fax_number": "443-602-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL GENOME DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-28",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "336-436-5402"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21D2039282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "21D2039282",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Person-Centered Health Group Inc
• Person-Centered Health Group Inc
• Person-Centered Health Group Inc
• Gloria Person
• Jonathan Person
• Personal Injury Management Center LLC
• Personal Rehabilitation Services Inc
• Personaleyes LLC
• Persons With Silent Disabilities Association
• Alexander D Persons, LCSW-C

• Clinical Medical Laboratory in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Medical Laboratory in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.