Diverse Diagnostics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

DIVERSE DIAGNOSTICS LLC

Practice address

3706 Crondall LN Ste 101a
Owings Mills, MD 21117-2234

Phone

(410) 807-8579

NPI assigned

Jul 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rodeny Blockston

Title

Lab Manager

Phone

(443) 888-2733

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1467070672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3706 CRONDALL LN STE 101A",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211172234",
            "telephone_number": "443-888-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3706 CRONDALL LN STE 101A",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211172234",
            "telephone_number": "410-807-8579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSE DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "BLOCKSTON",
        "authorized_official_first_name": "RODENY",
        "authorized_official_title_or_position": "LAB MANAGER",
        "authorized_official_telephone_number": "443-888-2733"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.