1518075753 NPI number — AMERICAN DIAGNOSTIC MEDICINE

Table of content: (NPI 1518075753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518075753 NPI number — AMERICAN DIAGNOSTIC MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN DIAGNOSTIC MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518075753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20768-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-212-7009
Provider Business Mailing Address Fax Number:
321-383-3101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7235 HANOVER PKWY
Provider Second Line Business Practice Location Address:
SUITE A & B
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-212-7009
Provider Business Practice Location Address Fax Number:
321-383-3101
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERMANSON
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
866-212-7009

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1KBT1 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G830 . This is a "CAREFIRST BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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