AMERICAN DIAGNOSTICS SERVICES LLC

Provider Demographics

• NPI: 1639140387
• Name: AMERICAN DIAGNOSTICS SERVICES LLC
• Entity Type: Organization
• Organization Name: AMERICAN DIAGNOSTICS SERVICES LLC
• Other - Org Name: TRIDENTCARE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: AUTHORIZED OFFICIAL/CFO
• Authorized Official - First Name: BRIAN
• Authorized Official - Middle Name: C
• Authorized Official - Last Name: CUOMO
• Authorized Official - Phone: 800-786-8015
• Mailing Address - Street 1: 930 RIDGEBROOK ROAD
• Mailing Address - Street 2: 3RD FLOOR
• Mailing Address - City: SPARKS
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21152-9390
• Mailing Address - Country: US
• Mailing Address - Phone: 800-786-8015
• Mailing Address - Fax: 410-472-1754
• Practice Address - Street 1: 2505 LORD BALTIMORE DRIVE
• Practice Address - Street 2: SUITE E
• Practice Address - City: WINDSOR MILL
• Practice Address - State: MD
• Practice Address - Zip Code: 21244-2639
• Practice Address - Country: US
• Practice Address - Phone: 410-295-3565
• Practice Address - Fax: 443-842-7264
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-31
• Last Update Date: 2024-02-15

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	293D00000X	Laboratories	Physiological Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	038913700	Other	KEYSTONE
IA	1487954913	Medicaid
MN	1487954913	Medicaid
IN	200980860A	Medicaid
DE	250540997	Medicaid
PA	2563931	Other	AETNA
WV	3910006905	Medicaid
MD	417010500	Medicaid
KY	7100156790	Medicaid
PA	0389137000	Other	IBC
AL	119726	Medicaid
NH	3081146	Medicaid
PA	0015026330013	Medicaid
NE	10026119900	Medicaid
MI	1639140387	Medicaid
MO	1639140387	Medicaid
NJ	7660804	Medicaid
PA	10661	Other	ELDERHEALTH
PA	1639140387	Medicaid
PA	19531	Other	HEALTH/SENIOR PARTNERS
KS	200726830A	Medicaid
OH	2839585	Medicaid
NJ	91000047800	Other	AMERICHOICE
NY	03340952	Medicaid
PA	0389137000	Other	AMERIHEALTH
NJ	1035442	Other	HORIZON MERCEY
TN	1523253	Medicaid
VA	1639140387	Medicaid
OK	200409010A	Medicaid
SC	SL0101	Medicaid
NJ	118225200	Other	DEPT. OF LABOR
NJ	499596	Other	AETNA
DE	FDCUV1	Medicare PIN
MD	470000039	Medicare PIN
RI	479006170	Medicare PIN
NJ	91000047800	Other	AMERICHOICE
IN	200980860A	Medicaid
PA	021344	Medicare PIN
OH	AMID03141	Medicare PIN
GA	202G472694	Medicare PIN
AL	102G471251	Medicare PIN
MA	0006464	Medicare PIN
NJ	118225200	Other	DEPT. OF LABOR
PA	10661	Other	ELDERHEALTH
DE	1639140387	Medicaid
CT	D300000010	Medicare PIN
PA	2563931	Other	AETNA
KS	KA1600	Medicare PIN
DE	470000040	Medicare PIN
DC	160768	Medicare PIN