Provider Demographics
NPI:1477554889
Name:AMERICAN DIAGNOSTIC LABORATORIES, INC.
Entity Type:Organization
Organization Name:AMERICAN DIAGNOSTIC LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-589-9005
Mailing Address - Street 1:1109 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4032
Mailing Address - Country:US
Mailing Address - Phone:301-589-9005
Mailing Address - Fax:301-589-9004
Practice Address - Street 1:1109 SPRING ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4002
Practice Address - Country:US
Practice Address - Phone:301-589-9005
Practice Address - Fax:301-589-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1079291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDY32327Medicare UPIN
MDF00018Medicare ID - Type Unspecified