21D0212217 CLIA NUMBER - SHADY GROVE PEDIATRIC ASSOCIATES

Laboratory Demographics

  • CLIA Code: 21D0212217
  • Facility Name: SHADY GROVE PEDIATRIC ASSOCIATES
  • Facility Address: 15215 SHADY GROVE ROAD SUITE 303
    ROCKVILLE, MD
    ZIP 20850
  • Facility Phone: 301 330-3216
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MINDY J. MAGGID MD
  • NPI Number: 1962597021
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D0212217
LAB Type Physician Office
Facility Name SHADY GROVE PEDIATRIC ASSOCIATES
Street 15215 SHADY GROVE ROAD SUITE 303
City ROCKVILLE
State MD
ZIP 20850
Phone 301 330-3216
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director MINDY J. MAGGID MD

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