Prime Diagnostics

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

21-D1057808 Issued in MD

Legal business name

PRIME DIAGNOSTICS

Practice address

4300 Forbes Blvd
Lanham, MD 20706-4314

Phone

(301) 459-5200

Fax

(301) 459-5400

NPI assigned

Jul 7, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Sujwala Puttagunta Boppudi, MS, MBA

Title

President

Phone

(301) 459-5200

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234828800000",
    "number": "1316979701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 BROOKFIELD CORPORATE DR STE 205",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511693",
            "telephone_number": "703-378-8100",
            "fax_number": "703-378-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 FORBES BLVD",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064314",
            "telephone_number": "301-459-5200",
            "fax_number": "301-459-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2009-02-17",
        "status": "A",
        "authorized_official_last_name": "BOPPUDI",
        "authorized_official_first_name": "SUJWALA",
        "authorized_official_middle_name": "PUTTAGUNTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-459-5200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, MBA"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21-D1057808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010400635",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039531500",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412222400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Press, MD
• Myasia Price-Cleare, MOT, OT/LT
• Joella C Price
• Lawan Lynette Price
• Angelica Prieto
• Primetime Physical Therapy and Rehab
• Prince George'S County Health Department
• Prince Moses DDS LLC
• Privia Medical Group, LLC
• Jessica Marie Proctor

• Clinical Medical Laboratory in Lanham, MD
• Providers in Lanham, 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 Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.