Healthcare Provider Details

I. General information

NPI: 1215074042
Provider Name (Legal Business Name): AMERICAN DIAGNSOTIC LAB., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 ACUSHNET AVE
NEW BEDFORD MA
02746-1905
US

IV. Provider business mailing address

1173 ACUSHNET AVE
NEW BEDFORD MA
02746-1905
US

V. Phone/Fax

Practice location:
  • Phone: 508-984-5200
  • Fax: 508-996-8614
Mailing address:
  • Phone: 508-984-5200
  • Fax: 508-996-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH CARDOSO MEDEIROS
Title or Position: MANAGER
Credential:
Phone: 508-984-5200