21D0219657 CLIA NUMBER - MEDSTAR MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 21D0219657
  • Facility Name: MEDSTAR MEDICAL GROUP
  • Facility Address: 5601 LOCH RAVEN BLVD
    BALTIMORE, MD
    ZIP 21239
  • Facility Phone: 443 444-5600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DAVID J. NAIMAN
  • NPI Number: 1093368409
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 21D0219657
LAB Type Physician Office
Facility Name MEDSTAR MEDICAL GROUP
Street 5601 LOCH RAVEN BLVD
City BALTIMORE
State MD
ZIP 21239
Phone 443 444-5600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Physician Office
Lab Director DR. DAVID J. NAIMAN

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