Provider Demographics
NPI:1518075753
Name:AMERICAN DIAGNOSTIC MEDICINE
Entity Type:Organization
Organization Name:AMERICAN DIAGNOSTIC MEDICINE
Other - Org Name:FIRST PET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-212-7009
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-1139
Mailing Address - Country:US
Mailing Address - Phone:866-212-7009
Mailing Address - Fax:321-383-3101
Practice Address - Street 1:7235 HANOVER PKWY
Practice Address - Street 2:SUITE A & B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3601
Practice Address - Country:US
Practice Address - Phone:877-212-7009
Practice Address - Fax:321-383-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1KBT1OtherBLUE SHIELD
MDG830OtherCAREFIRST BLUE SHIELD
MD1KBT1OtherBLUE SHIELD