Provider Demographics
NPI:1790821742
Name:MEDICAL DIAGNOSIS AID CENTER
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSIS AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:G
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-321-0662
Mailing Address - Street 1:300 E JOPPA ROAD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-321-0662
Mailing Address - Fax:410-296-1011
Practice Address - Street 1:300 E JOPPA ROAD
Practice Address - Street 2:SUITE 319
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-321-0662
Practice Address - Fax:410-296-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD263291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
T1240001OtherFED BCBS
39940101OtherBCBS
39940101OtherBCBS