Clinical Laboratory Information
Similar CLIA Codes
|
|
CLIA Number
|
21D2111253
|
|
Clinical laboratory number
|
|
Lab Name
|
PREMISE HEALTH OF MARYLAND MEDICAL, PC
|
|
Laboratory Name
|
|
Lab Type
|
Physician Office
|
|
Laboratory Type
|
|
Certificate Type
|
Waiver
|
|
Clinical laboratory certificate type
|
Contacts |
|
Phone
|
240-513-3590
|
|
Laboratory telephone number
|
|
Fax
|
301-797-4975
|
|
Fax number of the provider.
|
Facility Location |
|
Street Address
|
13302 PENNSYLVANIA AVENUE
|
|
Primary location adress line
|
|
City
|
HAGERSTOWN
|
|
Primary location city name
|
|
State
|
MD
|
|
Primary location state name
|
|
Zip
|
21742
|
|
Primary location postal code
|