21D0212156 CLIA NUMBER - MONTGOMERY MEDICAL ASSOCIATES

Laboratory Demographics

  • CLIA Code: 21D0212156
  • Facility Name: MONTGOMERY MEDICAL ASSOCIATES
  • Facility Address: 10110 MOLECULAR DRIVE STE 206
    ROCKVILLE, MD
    ZIP 20850
  • Facility Phone: 301 279-2779
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANUSHIRAVAN DADGAR DO
  • NPI Number: 1386089183
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0212156
LAB Type Physician Office
Facility Name MONTGOMERY MEDICAL ASSOCIATES
Street 10110 MOLECULAR DRIVE STE 206
City ROCKVILLE
State MD
ZIP 20850
Phone 301 279-2779
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2023
Certificate Expiration Date 12/7/2025
Facility Type Physician Office
Lab Director ANUSHIRAVAN DADGAR DO

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This page was last updated on: 9/29/2025