21D0215137 CLIA NUMBER - LIFEBRIDGE PRIMARY CARE OF NORTH CARROLL DA ROCHA MD LLC

Laboratory Demographics

  • CLIA Code: 21D0215137
  • Facility Name: LIFEBRIDGE PRIMARY CARE OF NORTH CARROLL DA ROCHA MD LLC
  • Facility Address: 4231 NORTHWOODS TRAIL
    HAMPSTEAD, MD
    ZIP 21074
  • Facility Phone: 410 374-9391
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: REBECCA A. GOEDEKE MD
  • NPI Number: 1730420811
  • Taxonomy: 363AM0700X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 21D0215137
LAB Type Physician Office
Facility Name LIFEBRIDGE PRIMARY CARE OF NORTH CARROLL DA ROCHA MD LLC
Street 4231 NORTHWOODS TRAIL
City HAMPSTEAD
State MD
ZIP 21074
Phone 410 374-9391
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/20/2024
Certificate Expiration Date 10/19/2026
Facility Type Physician Office
Lab Director REBECCA A. GOEDEKE MD

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