21D0211975 CLIA NUMBER - RCCA MD LLC- CHOP

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Laboratory Demographics

CLIA Number: 21D0211975

Facility Name: RCCA MD LLC- CHOP

Facility Address:
18111 PRINCE PHILLIPS DRIVE, SUITE 327
OLNEY, MD
ZIP 20832
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Facility Phone Number: 301 774-6136

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1366009938

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	21D0211975
LAB Type	Physician Office
Facility Name	RCCA MD LLC- CHOP
Street	18111 PRINCE PHILLIPS DRIVE, SUITE 327
City	OLNEY
State	MD
ZIP	20832
Phone	301 774-6136
CertificateType	2
CertificateEffectiveDate	11/25/2022
CertificateExpirationDate	11/24/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024