1700865094 NPI number — SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC

Table of content: (NPI 1700865094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700865094 NPI number — SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
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:
1700865094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 RIDGEBROOK RD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21152-9390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-786-8015
Provider Business Mailing Address Fax Number:
443-662-4230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 RIDGEBROOK RD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21152-9390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-786-8015
Provider Business Practice Location Address Fax Number:
443-662-4230
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUOMO
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/CFO
Authorized Official Telephone Number:
800-786-8015

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 095566 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100121370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 415092900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000189649 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03106321 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013217769 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700865094 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3910006821 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9419801 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00320-5515A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086063701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519090 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19423000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2374656 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42506100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7519206 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100365530A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006117 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86000247 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: B7883 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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