21D0219187 CLIA NUMBER - MEDSTAR MEDICAL GROUP AT WILKENS MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 21D0219187

Facility Name: MEDSTAR MEDICAL GROUP AT WILKENS MEDICAL CENTER

Facility Address:
4660 WILKENS AVENUE SUITE 100
BALTIMORE, MD
ZIP 21229
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Facility Phone Number: 410 247-0782

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578250734

Taxonomy: 2084P0800X - Psychiatry & Neurology
A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

CLIA Record

Field Name	Field Value
CLIA Number	21D0219187
LAB Type	Physician Office
Facility Name	MEDSTAR MEDICAL GROUP AT WILKENS MEDICAL CENTER
Street	4660 WILKENS AVENUE SUITE 100
City	BALTIMORE
State	MD
ZIP	21229
Phone	410 247-0782
CertificateType	4
CertificateEffectiveDate	12/6/2023
CertificateExpirationDate	12/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024