21D0214463 CLIA NUMBER - CHARTER INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 21D0214463
  • Facility Name: CHARTER INTERNAL MEDICINE LLC
  • Facility Address: 2470 LONGSTONE LANE SUITE I
    MARRIOTTSVILLE, MD
    ZIP 21104
  • Facility Phone: 410 910-2300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RANDAL P. RIESETT
  • NPI Number: 1750492419
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D0214463
LAB Type Physician Office
Facility Name CHARTER INTERNAL MEDICINE LLC
Street 2470 LONGSTONE LANE SUITE I
City MARRIOTTSVILLE
State MD
ZIP 21104
Phone 410 910-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Physician Office
Lab Director DR. RANDAL P. RIESETT

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