Mitra RXDX

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MITRA RXDX

Doing business as

MitraBiotech

Practice address

12 Gill St Ste 3150
Woburn, MA 01801-1777

Phone

(339) 999-2300

Fax

(339) 999-2399

NPI assigned

Sep 20, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Nowland

Title

Sr. VP Ra/Qa

Phone

(339) 999-2300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MitraBiotech Doing business as

Locations

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

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790294908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 GILL ST STE 3150",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011777",
            "telephone_number": "339-999-2300",
            "fax_number": "339-999-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 GILL ST STE 3150",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011777",
            "telephone_number": "339-999-2300",
            "fax_number": "339-999-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITRA RXDX",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "NOWLAND",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "SR. VP RA/QA",
        "authorized_official_telephone_number": "339-999-2300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NOT APPLICABLE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MitraBiotech",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mindy S Kopolow PSYD PA
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• Beatrice Mitchell, RN
• India Mitchell
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• MJV, LLC
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• Paula Modest
• Tiffany Marie Moglia, PA-C

• Clinical Medical Laboratory in Woburn, MA
• Providers in Woburn, MA by specialty
• Clinical Medical Laboratory in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.