Personalized Medicine Care Diagnostics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PERSONALIZED MEDICINE CARE DIAGNOSTICS LLC

Practice address

20271 Goldenrod LN FL 2, Unit:2099
Germantown, MD 20876-4064

Phone

(202) 531-3136

NPI assigned

Apr 28, 2020

Last updated

May 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sherry Dadgar

Title

Owner

Phone

(202) 531-3136

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

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

Locations

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1093336349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20271 GOLDENROD LN FL 2, UNIT:2099",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208764064",
            "telephone_number": "202-531-3136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20271 GOLDENROD LN FL 2, UNIT:2099",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208764064",
            "telephone_number": "202-531-3136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED MEDICINE CARE DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-28",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "DADGAR",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "202-531-3136"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Amelia Pennington, MD
• Liza Tairanis Perdomo Alvarez, BEHAVIOR ASSISTANT
• Michelle F Pereira, PSY.D.
• Giselle Perera
• Bianca Isabel Perez Lutz, DPT
• Menikina A. Pesce, M.D.
• Lourdes Sangeetha Pesseh, LCSW-C
• Youri Petcherkin
• Peter Kwon DDS LLC
• Johan Peters, LMSW

• Clinical Medical Laboratory in Germantown, MD
• Providers in Germantown, 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 7, 2021; 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.