21D0212907 CLIA NUMBER - PRIME PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 21D0212907
  • Facility Name: PRIME PEDIATRICS, LLC
  • Facility Address: 845-B QUINCE ORCHARD BLVD
    GAITHERSBURG, MD
    ZIP 20878
  • Facility Phone: 301 977-2440
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FARNOUSH JAMALI
  • NPI Number: 1316286032
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 21D0212907
LAB Type Physician Office
Facility Name PRIME PEDIATRICS, LLC
Street 845-B QUINCE ORCHARD BLVD
City GAITHERSBURG
State MD
ZIP 20878
Phone 301 977-2440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director FARNOUSH JAMALI

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