Healthcare Provider Details

I. General information

NPI: 1740106384
Provider Name (Legal Business Name): SPECIALTY MOBILE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 HARFORD RD
BALTIMORE MD
21214-3205
US

IV. Provider business mailing address

4709 HARFORD RD
BALTIMORE MD
21214-3205
US

V. Phone/Fax

Practice location:
  • Phone: 410-240-0404
  • Fax:
Mailing address:
  • Phone: 410-240-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: SIARA PRIDGEN
Title or Position: FOUNDER & CEO
Credential: PRIDGEN
Phone: 410-240-0404